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This 29 year old man was the driver of a pickup truck which collided head-on with another car and rolled onto the passenger's side.  The passenger was dead at the scene.  The driver was found with his body outside the driver's side window and head inside the truck, caught around the seatbelt.  Paramedics applied a KED and semirigid C-spine collar at the scene and he was brought to the closest hospital.  IV Steroids were instituted for a suspected C-spine injury and he was transfered to a tertiary care centre. On arrival, his airway is patent, the C-spine is in a semirigid collar, and he his hemodynamically stable on 100% Oxygen.  Physical examination reveals tenderness in the mid-to-lower C-spine.  Neurological examination shows that this man has a C6 sensory and motor level.  There is no rectal tone and a negative bulbocavernosus reflex is noted.  There are no other injuries.


Radiographs of the C-spine

c2_1ap.jpg (15040 bytes)  c2_1lat.jpg (17757 bytes)  c2_1ct.jpg (15660 bytes)

A Halo is applied on admission, and sequential weights are used to attempt a closed reduction of the C-spine:

  (After 20 Lbs)
c2_20lb.jpg (14757 bytes)

(After 30 Lbs)
c2_30lb.jpg (17036 bytes)

The C-spine reduces with 40 lbs weight but the neurological deficit persists.

The patient was taken to the operating room the following day for instrumentation.

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