Delayed presentation of subaxial cervical spine dislocations: A retrospective review of 14 cases managed at a specialist spinal surgery unit in Durban, South Africa

  • Anand Balasubramanian
  • Govender Shanmugam
Keywords: subaxial cervical spine dislocation, delayed presentation, missed subaxial injuries, late presentation, cervical spine dislocation, cervical spine injuries, South Africa


Background: The subaxial cervical spine is the most commonly injured region of the spinal column and these injuries are frequently missed. The objective of this case series (n=14) was to highlight the issues encountered with delayed presentation (> 2 weeks) of sub axial cervical spine dislocations/fracture dislocations and the outcomes following surgical management of these injuries.

Methods: We analyzed 14 adults with 9 unifacet and 5 bifacet dislocations who presented after a mean delay of 27.3 days. Demographic profile, mechanism of injury, reasons for delayed presentation, pre-operative imaging studies, clinical presentation, surgical management, complications and outcomes were analyzed. A literature review was also undertaken to assess the incidence, etiology and outcomes associated with these injuries and highlight methods available for appropriate screening of the cervical spine in an attempt to mitigate delays.

Results: Pre-operative reduction with skull traction was unsuccessful in 3 out of 5 bifacet dislocations while all but one unifacet dislocations were reduced successfully. All injuries were managed operatively with anterior cervical discectomy and fusion (ACDF) with instrumentation.

Posterior release prior to anterior discectomy and fusion were performed in 3 patients where dislocations were irreducible pre-operatively. Neurological improvement was seen in 9 patients.

Conclusions: A favorable outcome can be expected following surgery for delayed presentation of sub axial cervical spine injuries, especially in the resource limited, low- and middle-income countries (LMICs).

Case Series