Late neurological deterioration 30 years following conservative treatment of a lower cervical spine fracture--a case report.

A today 44 years old man suffered from a compression and subluxation fracture of C 4 and C 5 vertebral body during a swimming accident in 1971. The primary therapy was conservative and the patient was rehabilitated. Since 1997 the patient showed a slowly progressive right hemiparesis with signs of cervical myelopathy. The diagnostic procedures revealed a severe deformity of the cervical spine with myelon compression. We performed an operation with replacement of C4 and C5 and dorsal stabilization at the same time. This very impressive case shows the risk of a late and slowly onset of myelopathic deterioration while latent bony instability persist post traumatic. The authors think in agreement with the actual literature that the early operative stabilization of instable fractures of the lower cervical spine is inevitable. According to the grade of neurological and bony damage the operation should not be performed later than 8-12 hours after injury.