The patient a Saudi citizen came to the clinic 18-July-2010 complaining of numbness 10 cm below the nipple with weak extensors of both hands 4/5 and triceps both arms 3/5 for 5 months. 6 months ago he was involved in quarrel and he complain of neck pain, which resolved after several days.

MRI of the cervical spine performed 30-June-2010 showing fracture dislocation C7-D1 with malacia of the spinal cord and compression of the spinal cord at this level. MRI repeated 12-July-2010 showing the same findings.

On examination: the patient walking with crutches for 2 months. He has weak extension of both hands 4/5 and triceps both arms 3/5. There is para-aneasthesia for pin-brick and touch below D5. All the muscles of both lower limbs are 4/5. He has micturiton and defecation problems.

The patient was admitted 19-July-2010 and dexametasone 8 mg TID was started.

Discectomy of C7-D1 was achieved and open reduction was performed until the alignments became proper. A cage 4.5 mm thickness with novabone was inserted and Zimmer miniplate was used with 14mm length screws with 4.5 mm diameter to fuse C7-D1. Before that the osteophytes in the anterior upper edge of D1 were removed to provide more correction of the dislocation. Serial check-ups was performed at all stages of the operation.

Routine closure of the wound and smooth postoperative recovery.

The power of all limbs dramatically improved.

The patient suffered trauma 6 months ago and the neurological deterioration took place 1 month after the insult. This could be explained by the presence of fracture in the lateral masses without dislocation of the C7 over D1. After 1 month the fatigue fracture developed to dislocation, which caused spinal cord compression and malacia.

Surgical reduction and fusion is the only solution, since pseudoarthrosis took place and no hope for future ossification of the unstable segment  in the near and far future.