The patient was admitted 10 days ago for multiorgan injuries after RTA and was operated for internal bleeding and put in ventilator. Upon recovery from ventilation, it was noticed that he had right lower limb plegia and CT-scan performed showed brain edema and suggestion for axonal injury of the left internal capsule was put clinically. He had also weak right upper limb more the proximal muscles. Fracture of the D5 was suspected and confirmed by CT-scan, but there was no gross displacement.
Upon activation of the patient 2 days ago, the patient progressed dense paraplegia below Th 5.

MRI of the brain and the whole spine was performed and confirmed the presence of damage to the left internal capsule and presence of severe fracture-dislocation of C7-D1.

The patient was operated the next day and after reduction of C7 upon D1, discectomy of C7-D1 was performed. The upper anterior part of the D1 body was badly destroyed. Using cervical miniplate, fusion of C7-D2 was performed and the chips of the fractured bone put back to place. Another screw was used to fix the left part of the more or less acceptable part of D1 body.

Smooth postoperative recovery. Neurologically the same.

The patient has 2 causes of his neurologic problem, the internal capsule and the hidden fracture dislocation of C7-D1. Presence of minor fracture of D5 misled and hided the presence of the major fracture-dislocation at C7-D1 which is difficult to note in the usual X-rays. This later caused the further neurologic deterioration upon his activation.

This case support the need for whole body MRI of the patient in the early stage of the multiorgan trauma to avoid such mistakes.