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Objective Traumatic high-grade cervical spinal dislocations are rare injuries, generally associated with severe neurological compromise. In particular, cervical spondyloptosis (>100% subluxation) is rarely reported. The object of our study is to present a case series describing presentation, management, and outcome in traumatic high-grade cervical spinal dislocations. Methods Retrospective analysis was performed involving two level 1 trauma centers. Patients with a high-grade traumatic cervical subluxation were selected from a database, and these patients were admitted between August 2007 and July 2011. Results Fifteen patients were identified; three had spondyloptosis. The admission American Spinal Injury Association Impairment Scale (AIS) grade varied (A = 9; B = 2; C = 1; D = 2; E = 1). Fourteen patients underwent attempted closed reduction with six (43%) failing closed reduction. High-dose methylprednisolone was administered in nine patients (60%). All patients underwent surgical stabilization: three underwent anterior only, three underwent posterior only, and nine underwent a combined anterior-posterior approach. Postoperatively, one patient improved two AIS grades, three improved one AIS grade, nine maintained their preoperative score, and two patients worsened. Conclusions In this series, 26.7% of patients had improvement in their AIS grade postoperatively, and the majority of patients (60%) maintained their preoperative AIS grade. In 57% of patients placed in traction, reduction was possible. Likely due to the severity of these injuries, there was a high incidence of complications. However, review of patient outcomes reveals that these patients can have improvement of neurological function. We recommend aggressive reduction and surgical stabilization. Our preference is either a combined anterior-posterior approach or a posterior-only approach.

The prognosis for substantial and lasting neurological recovery after complete traumatic spinal cord injury (SCI) remains dismal. Disruption of motor and sensory pathways involving not only limb activity, but also respiratory, urinary, and autonomic function, contributes to lifelong morbidity. Obstacles impeding the spinal cord’s ability for self-repair are multifactorial. Principal among these, however, is the limited growth potential of the injured spinal cord, as well as the problematic task of functionally reconnecting supraspinal to spinal neurons, and vice versa. Exciting recent developments in preclinical SCI research, however, are bringing to light novel strategies for circumventing these barriers to spinal recovery with potential for near-future translational therapies. Contrary to traditional thought, axons within the injured adult spinal cord have the capacity to grow, if given optimal circumstances. The propensity for spontaneous axonal growth, however, is limited by the extent of the intrinsic growth potential of adult neurons, and the degree of growth inhibition mediated by the injured cord. A significant component of the inhibitory, internal milieu after injury is due to the presence of chondroitin sulfate proteoglycans (CSPGs) (2, 10). CSPGs are molecules found within the perineuronal net, which have been identified as key factors in preventing axonal growth. Under normal conditions, CSPGs likely function to stabilize mature axons and prevent aberrant growth. After injury, CSPGs are up-regulated at the glial scar that forms at the injury site, and around partially denervated neurons distal to the injury. This increase in CSPGs causes sprouting axons to dieback as they approach the injury epicenter, thereby failing to restore connectivity. Chondroitinase ABC (ChABC) is an enzyme that cleaves the inhibition-mediating sugar chains of CSPGs. In animal models, intraspinal delivery of ChABC has been shown to promote a growth-permissive environment, facilitating spontaneous axonal growth across a spinal cord injury (3, 4). Lasting neurological recovery, however, requires not only axonal growth but also the re-establishment of functional connections between relevant supraspinal and spinal neurons. Precise restoration of point-to-point neural circuitry is a therapeutic challenge that is seemingly unrealistic, particularly of complex long distance neuronal pathways. Increasing recent scientific studies reveal, however, that under ideal conditions, spinal interneurons can sprout new axons after injury. More remarkably, growing