Usefulness of 3-dimensional full-scale Modeling for Preoperative simulation of surgery in a patient with old unilateral cervical fracture-dislocation

Study Design. Case report. Objective. We describe the usefulness of 3-dimensional full-scale modeling for preoperative simulation of surgery in a patient with old cervical fracture-dislocation. Summary of Background Data. Many different surgical procedures have been used in the treatment of unilateral cervical fracture-dislocation. However, consistent protocols and procedures for the surgical correction of old fracture-dislocations associated with nerve root lesions have not been established. Methods. Two months after an automobile accident, a 50-year-old man developed symptoms of left C5 palsy. Four months after the accident, he was diagnosed with a fracture-dislocation at left C4-C5 facet with impingement of the left C5 root at the neural foramen. In addition, his left vertebral artery was completely occluded. Spontaneous bony fusion had progressed around the left facet and the anterior aspect of the vertebrae at C4-C5. Before surgery, a 3-dimensional full-scale model in the patient's cervical spine was made in order to simulate the planned surgical reconstruction. Results. Through this simulation, we were able to accurately evaluate the deformed bony structures around the fractured C4-C5 facet. During the actual surgery, all the planned procedures were successfully achieved, including anterior release, insertion of pedicle screws at left C4 and C5, unroofing of the left C5 root, reduction of the displaced facet with the pedicle screw-rod system, and spinal fusion at C4-C5. After surgery, the patient's left C5 palsy was dramatically relieved and the spinal fusion went on to successful healing. Conclusion. The surgical simulation made possible by the 3-dimensional full-scale model appeared to simplify the surgical procedure and may enhance the safety of the complex spinal reconstruction.