This 34-year-old male presented within 4h of a barefoot waterskiing accident with a neurologically complete C6 tetraplegia. There was no sacral sparing present; the patient also had an absent bulbocavernosus reflex. Lateral plain cervical radiographs demonstrated a bilateral C6–7 facet dislocation. Along with intravenous methylprednisolone administration the patient underwent immediate closed reduction with cranial tong traction, without undergoing an MRI first. B) Following sequentially increasing cranial skeletal traction, the facets were found to be perched on lateral radiographs at 60 pounds traction. The patient noticed immediate recovery of trunk and leg sensation. C) The facet dislocation reduced with 80 pounds traction. No manipulation was used for the reduction sequence. Notice the overdistraction at the C6–7 interspace. D) Following reduction, the traction weight was reduced to 20 pounds in order to avoid potential damage from persistent overdistraction. The entire duration from initial presentation to complete reduction lasted for 45min. The patient was kept in a rotating bed. E) A postreduction MRI scan was obtained to exclude a persistent space-occupying lesion affecting the spinal cord. This T2-weighted MRI scan demonstrates anterior and posterior discoligamentous injuries to the C6–7 segment and confirms absence of any residual cord compression. Increased signal within the cord substance is reflective of cord haemorrhage. F) and G) The patient received anterior cervical discectomy and fusion at C6–7 48h after injury. Apart from unilateral C7 root pain the patient made a full neurologic recovery within 5 days of his injury. These lateral cervical flexion–extension radiographs demonstrate solid fusion in anatomic alignment. H) At 5 months postinjury the patient received an MRI scan to assess his unilateral C7 radiculopathy. A focal area of spinal cord injury probably representing gliosis was noted at the C6–7 interspace. There was no evidence of any residual cord or nerve root compromise.
