It was decided to perform an Anterior and Posterior Approach in 2 surgical times. Cervical traction Gardner Wells-type was performed previously; using weight of 120 kg for 3 min, the fracture was reduced successfully. C6 corpectomy and C7 partial corpectomy was performed, double discectomy C5-C6 ; C6-C7, achieving correction of the displacement, bone graft C6 - C7 of the right iliac crest is placed, fixation with a simple plate is performed, screws fixation was placed on C5 and C7 vertebral body bone. Bibliography 1 - Withington ET. Hippocrates. On Wounds in the Head. In the Surgery. On Fractures. On Joints. Mochlicon. Loeb Classical Library 149. Cambridge, MA: Harvard University Press. 1928 - National Spinal Cord Injury Statistical Center. Spi_x0002_nal Cord Injury: Facts andFigures at a Glance (www. spinalcord.uab.edu). Birmingham, AL: Universityof Alabama (Accessed June 2, 2005). • 2.- Tator CH, Fehlings MG. Review of the secondary injury theory of acute spinal cord trauma with emphasis on vascular mechanisms. J Neurosurg 1991;75:15– 26. • 3.- Blight AR. Cellular morphology of chronic spinal cord injury in the cat: analysis of myelinated axons by line sampling. Neuroscience 1983;10:521–43. • 4.- Bracken MB, Shepard MJ, Collins WF, et al. A rand_x0002_omized controlled trial of methylprednisolone or nalox_x0002_one in the treatment of acute spinal cord injury. N Engl J Med 1990;322:1405–117 5.-AOSpine Continuous Training Program. trauma. Classification of vertebral traumatic injuries. Author: Dr. Alexandre Sadao Iutaka.Editor.Dr. Nestor Fiore 1 - Withington ET. Hippocrates. On Wounds in the Head. In the Surgery. On Fractures. On Joints. Mochlicon. Loeb Classical Library 149. Cambridge, MA: Harvard University Press. 1928 - National Spinal Cord Injury Statistical Center. Spi_x0002_nal Cord Injury: Facts andFigures at a Glance (www. spinalcord.uab.edu). Birmingham, AL: Universityof Alabama (Accessed June 2, 2005). • 2.- Tator CH, Fehlings MG. Review of the secondary injury theory of acute spinal cord trauma with emphasis on vascular mechanisms. J Neurosurg 1991;75:15– 26. • 3.- Blight AR. Cellular morphology of chronic spinal cord injury in the cat: analysis of myelinated axons by line sampling. Neuroscience 1983;10:521–43. • 4.- Bracken MB, Shepard MJ, Collins WF, et al. A rand_x0002_omized controlled trial of methylprednisolone or nalox_x0002_one in the treatment of acute spinal cord injury. N Engl J Med 1990;322:1405–117 5.-AOSpine Continuous Training Program. trauma. Classification of vertebral traumatic injuries. Author: Dr. Alexandre Sadao Iutaka.Editor.Dr. Nestor Fiore 1 - Withington ET. Hippocrates. On Wounds in the Head. In the Surgery. On Fractures. On Joints. Mochlicon. Loeb Classical Library 149. Cambridge, MA: Harvard University Press. 1928 - National Spinal Cord Injury Statistical Center. Spi_x0002_nal Cord Injury: Facts andFigures at a Glance (www. spinalcord.uab.edu). Birmingham, AL: University of Alabama

1. Topic Presentation:
Clowards Anterior
with Interbody fusion in
patient with AO Spine C
Cervical Fracture and
Séquard Syndrome.
damianlastra2@gmail.com

2. Clowards Anterior Approach with Interbody
fusion in a patient with AO Spine C Cervical
Fracture and Brown Séquard Syndrome.
Case Presentation
Dr. Damian Lastra Copello. Consultant Neurosurgeon. Emergency and
Critical Care Fellowship. Medical Director at Christmas International Brain
and Spine Surgery Specialized Center. Ethiopia. Havana University. Cuba.
Dr. Yohana Camejo Sánchez. Consultant Neurosurgeon, Comprehensive
General Medicine Specialist. Emergency and critical Care Fellowship.
Christmas International Brain and Spine Surgery Specialized Center. Addis
Ababa Ethiopia. Havana University. Cuba.

3. “…A task may
seem impossible
until it is
done…”
Nelson Mandela

4. Spinal Surgery From Historical
Perspective
• Hippocrates (460-375 bce) is considered the
father of spinal surgery . He was the first
philosopher to describe the anatomy of the spine
• In the first half of 20th century. Bohler described
the treatment for Spinal Cord Injury with early
reduction of lesions.
• 1960 -Roy Camille and his teacher Judet began
to develop the approach of transpedicular screw
fixation.

5. Brown Séquard Syndrome.
• Charles-Édouard Brown-Séquard,
(born April 8, 1817, Port Louis,
Mauritius—died April 1, 1894,
Paris, France), French
physiologist and neurologist

6. Brow Séquard Syndrome.
1. Abolition of the deep tenderness at the lesion
site.
1. Disturbances of superficial sensation on the
opposite side, which goes from a simple
hypesthesia to anesthesia
2. Above the limit of the lesion there is a small
band of hyperesthesia, and on this a small zone
of radicular anesthesia,
3. May present signs of motor paralysis or
pyramidalism signs such as Babinski,
hyperreflexia and clonus.

7. Case Presentation:
• 42-year-old male patient who was
received at our center after suffering a
traffic car accident 24 hours before,
making it impossible for him to mobilize
upper and lower extremities in the right
hemibody. No history of chronic disease

9.  Right Hemiparesis- 2/5 on the Motor Grading
Scale. (Daniels Scale)
 Sensory level C5 in the left hemibody, with
preserved motility.
 Superficial sensitivity preserved on the right
side as well as alterations in deep sensitivity in
the same, given by hypopalesthesia.
 Presence of Clonus in the right lower limb
 ASIA (American Spinal Cord Injury Association)
Clasification - Type B
 Glasgow Coma Scale 15/15 points

10. Initial Treatment:
• Cervical spine control is performed with external
orthosis. (Philadelphia collar)
• Simultaneously, supplemental oxygen was placed
through a nasal catheter after checking permeability of
the airway and ventilatory mechanics without
alterations.
• A peripheral vein catheter was placed and NASCIS
protocol was performed 24 hours at a rate of 30
mg/kg/hour IV Start Dose + continuous perfusion at
rate of 5.4 mgs/kg/hour, for 23 hours.

11. • Brain CT Scan - Negative
• Thorax, Pelvic, Upper and Lower
Extremities X-ray.- Negative
• Abdominal Ultrasound- Negative
• Laboratory Tests: Normal Values

12. Cervical and Thoracic CT Scan.
Low Cervical Spine unstable Fracture C6-C7.- Allen
Clasification C. ( 39% rotation injury)
AO Spine Clasification for Cervical Fracture- Type C.

13. Type C lesions. AO Spine Clasification.
• Type C injuries are caused by a primary
mechanism of rotation/translation. There is
lesion of anterior and posterior elements. Even
without displacement, should be considered a
lesion Type C.

14. Cervical Spine MRI 1.

16. Treatment options and surgical
Approach decision.
1.- Anterior and posterior approach combined in a
single surgical time. (Corpectomy, disckectomy,
autologous graft placement, anterior plate fixation and
posterior approach with pedicle screw fixation, plus
decompressive laminectomy)
2. - Anterior approach in a first surgical time.
A second surgical time for posterior approach after 72
hours.

17. Corpectomy

18. Autologous bone tissue
graft

19. X-Ray Control with Image Intensifier
after fixation.

20. Surgery Performed. Description.
• It was decided to perform an Anterior and Posterior
Approach in 2 surgical times.
• Cervical traction Gardner Wells-type was performed
previously; using weight of 120 kg for 3 min, the fracture
was reduced successfully.
• C6 corpectomy and C7 partial corpectomy was
performed, double discectomy C5-C6 ; C6-C7,
achieving correction of the displacement, bone graft C6
- C7 of the right iliac crest is placed, fixation with a
simple plate is performed, screws fixation was placed
on C5 and C7 vertebral body bone.

21. Cervical Simple X Ray after 24 hours.
Autolog bone
tissue

22. Result 48 hours after surgery
• Patient with recovered motility in the right
hemibody 4/5 points on the Daniels
Scale.
• Superficial sensitivity without alterations
in both sides of the body.
• Deep sensitivity without alterations in
both sidesb of the body.

23. Clinical condition of the patient after
surgery

24. Taking into account medical principles
such as:
• Surgical treatment should be applied
according to the clinical condition of the
patient, not in the image
• Surgery is a treatment option to solve a
health problem in the patient, not to cause
another.
After discussion among the surgical team, it was decided
not to perform a second surgical intervention and keep the
patient under observation, medical treatment, and follow-
up.

25. Considerations about the case
• The patient was discharged without complications.
• It is essential to determinate whether the fracture is
stable or unstable.
• Reduction of fracture and decompression of are main
objectives in the surgical treatment of these patients.
• The combined anterior and posterior approach should
be the first option as surgical treatment.
• All neurosurgical patients undergo a treatment process,
which includes, among other pillars, surgery as the
central aim and treatment of possible complications
that may appear.

26. THANKS.
•THE END

27. Bibliography
• 1 - Withington ET. Hippocrates. On Wounds in the Head. In the
• Surgery. On Fractures. On Joints. Mochlicon. Loeb Classical
• Library 149. Cambridge, MA: Harvard University Press. 1928
• - National Spinal Cord Injury Statistical Center. Spi_x0002_nal Cord Injury: Facts
andFigures at a Glance (www. spinalcord.uab.edu). Birmingham, AL: Universityof
Alabama (Accessed June 2, 2005). •
• 2.- Tator CH, Fehlings MG. Review of the secondary injury theory of acute spinal cord
trauma with emphasis on vascular mechanisms. J Neurosurg 1991;75:15– 26. •
• 3.- Blight AR. Cellular morphology of chronic spinal cord injury in the cat: analysis of
myelinated axons by line sampling. Neuroscience 1983;10:521–43. •
• 4.- Bracken MB, Shepard MJ, Collins WF, et al. A rand_x0002_omized controlled trial
of methylprednisolone or nalox_x0002_one in the treatment of acute spinal cord injury.
N Engl J Med 1990;322:1405–117
• 5.-AOSpine Continuous Training Program. trauma. Classification of vertebral traumatic
injuries. Author: Dr. Alexandre Sadao Iutaka.Editor.Dr. Nestor Fiore