Images in Clinical Medicine
Reversal of Traumatic Quadriplegia after Closed Reduction
N Engl J Med 2008; 359:2154November 13, 2008
- Article
A 39-year-old woman was struck by a truck traveling at high speed. Cervical computed tomography showed a dislocation between the C5 and C6 vertebrae (Panel A, sagittal reconstruction). Physical examination revealed less than antigravity strength in the bilateral deltoids with no other movement in the limbs. A C7 level with no sacral sensation was found. Gardner–Wells tongs were applied, and a closed reduction was performed within 4 hours after the initial injury. After reduction, the patient immediately regained antigravity strength in both arms and both legs. A posterior cervical fusion was performed in the operating room to stabilize normal alignment (Panel B, with the arrow showing hardware). At a 3-year follow-up visit, the patient continued to have nearly full strength in all limbs and ambulated normally. A mild sensory deficit to a pinprick was noted on the left side. Bowel and bladder function were normal. As seen in this case, rapid intervention may allow recovery from traumatic spinal cord injury.
John A. Cowan, Jr., M.D.
John E. McGillicuddy, M.D.
University of Michigan Medical Center, Ann Arbor, MI 48104
