The patient came to the emergency of Al-Shmaisani hospital 03-October-2008 after suffering RTA 02-October-2008 with clinical picture of paraplegia at C6 level.

MRI of whole spine performed today showing unstable fracture of C6 and wedging of C7 with contusion and malacia of the spinal cord at theses levels.

On examination: the patient had complete paraplegia below D1 and severe paresis below C5 and paraaneasthesia below D4 left side and D2 right side.

The patient was put under observation for vital signs and massive dose of decadron was started.

The next day before surgery reevaluation confirmed improvement of the power of upper limbs with the biceps 4/5 and grip of the hands 3/5 and extension of the hands 3/5 and triceps 2/5 both sides.

In supine position with halo traction 5 Kg applied to the head, anterior approach to C5 down to D1 was achieved. Considering that the disci were in acceptable position, it was decided not to violate them. Check image-intensifier showed good reduction of the fractured C6 and C7.

Using Hybrid miniplate 48 mm length and 6 screws, fixation of C5, C7 and D1 was performed. The C6 was not included in screw insertion to avoid bone dislodgment during screw insertion. Serial check X-rays confirmed good alignment and good positioning of the construct.

Routine closure of the wound. The power of both upper limbs improved slightly and the patient could feel the toes with crude sensation better at the left side.

The patient has unstable fracture of C6 with wedging of C7.  Reduction and fixation is mandatory to prevent further trauma to the already traumatized spinal cord.

The improvement of the neurological deficit is drug induced and not related with surgery.