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Wednesday, May 21, 2008

4th and 5th Cervical Laminae-Acute Hemiparesis?

This interesting article published in the "Journal of Bone and Joint Surgery" describes spinal cord injuries at the C4-C5 level caused by a serious head-on vehicle collision in a 18 year old teenager. The accident resulted in invagination of C4-C5 laminae into the spinal canal and also fractures leading to hemiparesis?. Surgical intervention of laminectomy, fusion and stabilization with instrumentation resulted in recovery from right sided weakness and recovery of full neurological functions.

Traumatic invagination of the fourth and fifth cervical laminae with acute hemiparesis
U. R. Hähnle, L. Nainkin
From the University of the Witwatersrand, Johannesburg, South Africa

The patient was initially treated by skeletal traction (3 kg) applied using
Crutchfield tongs. As the neurological deficit did not recover
during the following week operation was undertaken.
Through a posterior approach, exposing the laminae and
lateral masses from C3 to C6, the invagination of the right
laminae of the C4 and the C5 vertebrae was confirmed. All
other posterior elements such as the facet joints, ligamentum
flavum, interspinous ligaments and spinous processes
were intact. The fracture at C2 was not exposed.
Reduction of the invaginated laminae was achieved by
gentle traction on the spinous processes. Mild flexion of the
neck helped to maintain the reduction. As the neck was
extended there was a tendency for the laminae to reinvaginate.
Transverse wiring of the two involved spinous processes
was undertaken with tension towards the left-sided
lateral masses to maintain the position of the reduced
Adequate decompression was confirmed on a postoperative
CT scan (Figs 3a and 3b).