Asian Spine J Search


Asian Spine J > Volume 7(2); 2013 > Article
Agrawal, Kumar, Ghotra, and Singh: Neglected Fracture-Dislocation of the Cervical Spine without Neurological Deficits
Dear Sir,
Neglected spinal injuries, either secondary to overlooked diagnosis [1] or due to circumstantial and socio-economic factors [2], are not uncommon but discussed infrequently in the literature [1,2]. A 72-year-old male had history of a slip and fall episode three years ago in a construction field. At that time, he had weakness of all four limbs with bowel and bladder involvement. He was managed conservatively because of financial instruments. He recovered completely over a period of six months. Now, he presented with mild persistent neck pain. On examination, except mild spasticity, there were no motor or sensory deficits. Initial magnetic resonance imaging of the cervical spine showed dislocation of C5 over C6, and the spinal cord was stretched over the dislocated vertebral bodies (Fig. 1). There was no evidence of cord edema or cord contusions. He had one follow up X-ray of the cervical spine at one year after the injury, and it showed a fusion of the C5 and C6 vertebral bodies (Fig. 2A). Recent X-ray of the cervical spine showed increased and complete ossification of the C5 and C6 vertebral bodies (Fig. 2B). In view of the solid fusion and no neurological deficits, the patient continued with conservative management with analgesics.
Patients with neglected spinal injuries can present with neck pain, restricted neck movements, or clinical features of progressive myelopathy [2-4]. Treatment of neglected spinal injuries needs to be individualized, depending on patient's age, medical condition, severity of myelopathy, and stability spine [5-8]. Aggressive surgical treatment is reserved for younger patients with progressive myelopathy, secondary to dynamic instability [9]. Conservative approach has been suggested for elderly patients with stable, non-progressive deformity [5-8]. In the present case, the reactive new bone formation around the fractured segments might have helped in preventing abnormal movements and development of myelopathy.
Neglected spinal injuries are defined as injuries not treated in a timely fashion and found late when options for care are limited [1]. Also, neglected spinal injuries may result when the comprehensive management is not initiated in a timely fashion [2]. These lesions have a much higher incidence of complications, which are more severe and difficult to manage, requiring longer hospitalization, adding to the costs and adversely affecting the functional outcomes [1,2].
In summary, for neglected spinal injuries, either untreated or inadequately treated with progressive deformity, persistent pain and late presentation are more often seen in the developing countries [1]. In rare circumstances (as in present case), neglected complete fracture-dislocations patients can make excellent recovery without neurological deficits [10].

Conflict of Interest

No potential conflict of interest relevant to this article was reported.


1. Sengupta DK. Neglected spinal injuries. Clin Orthop Relat Res 2005;(431): 93–103. PMID: 15685061.
crossref pmid
2. Chhabra HS, Arora M. Neglected traumatic spinal cord injuries: causes, consequences and outcomes in an Indian setting. Spinal Cord 2013;51:238–244. PMID: 23184027.
crossref pmid
3. Jain AK, Dhammi IK, Singh AP, Mishra P. Neglected traumatic dislocation of the subaxial cervical spine. J Bone Joint Surg Br 2010;92:246–249. PMID: 20130317.
crossref pmid
4. Ho AW, Ho YF. Atlanto-axial deformity secondary to a neglected odontoid fracture: a report of six cases. J Orthop Surg (Hong Kong) 2010;18:235–240. PMID: 20808019.
crossref pmid
5. Crockard HA, Heilman AE, Stevens JM. Progressive myelopathy secondary to odontoid fractures: clinical, radiological, and surgical features. J Neurosurg 1993;78:579–586. PMID: 8450331.
crossref pmid
6. Hart R, Saterbak A, Rapp T, Clark C. Nonoperative management of dens fracture nonunion in elderly patients without myelopathy. Spine (Phila Pa 1976) 2000;25:1339–1343. PMID: 10828914.
crossref pmid
7. Pepin JW, Bourne RB, Hawkins RJ. Odontoid fractures, with special reference to the elderly patient. Clin Orthop Relat Res 1985;(193): 178–183. PMID: 3971620.
8. Ryan MD, Taylor TK. Odontoid fractures in the elderly. J Spinal Disord 1993;6:397–401. PMID: 8274807.
crossref pmid
9. Kirankumar MV, Behari S, Salunke P, Banerji D, Chhabra DK, Jain VK. Surgical management of remote, isolated type II odontoid fractures with atlantoaxial dislocation causing cervical compressive myelopathy. Neurosurgery 2005;56:1004–1012. PMID: 15854248.
10. Sapkas GS, Stathakopoulos DP, Chronopoulos E, Papadakis S. Neglected complete fracture-dislocation at the cervico-thoracic level without neurological deficit. Injury 1998;29:385–389. PMID: 9813686.
crossref pmid
Fig. 1
Initial magnetic resonance imaging of cervical spine showing dislocation of C5 over C6 and the spinal cord was stretched over the dislocated vertebral bodies.
Fig. 2
(A) One follow-up X-ray of the cervical spine at one year after the injury showed fusion of C5 and C6 vertebral bodies, and (B) Recent X-ray of the cervical spine showed increased and complete ossification of the C5 and C6 vertebral bodies.


Browse all articles >

Editorial Office
Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine
88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea
Tel: +82-2-3010-3530    Fax: +82-2-3010-8555    E-mail:                
Korean Society of Spine Surgery
27, Dongguk-ro, Ilsandong-gu, Goyang-si 10326, Korea
Tel: +82-31-966-3413    Fax: +82-2-831-3414    E-mail:                

Copyright © 2024 by Korean Society of Spine Surgery.

Developed in M2PI

Close layer
prev next