Complex surgery saves man with rare injury

Doctors in Shanghai have successfully performed an ultra-complex surgery on a man with a severe neck injury akin to an "internal decapitation" after he was struck by a mechanical arm, saving his life.

The 55-year-old patient, surnamed Li, suffered a rare and severe cervical vertebra fracture and dislocation. He underwent reduction and fixation surgery at Shanghai Changzheng Hospital and was discharged in July. Upon release, he was able to move his shoulders and lift his wrists, doctors said.

The accident occurred on May 31 in Changshu, a city in neighboring Jiangsu province, when Li was hit from above by a mechanical arm. The blow caused catastrophic damage to his cervical spine. He immediately suffered high-level paralysis and cardiac arrest at the scene. His weak vital signs were restored only after receiving CPR.

On June 3, Li was transferred to Shanghai Changzheng Hospital. Imaging showed an extremely rare and extensive cervical dislocation, with a severe spinal cord contusion and tearing of critical nerve and vascular structures.

The patient was at a high risk of severe bleeding and vertebral artery injury, potentially causing shock or a fatal stroke. A massive hematoma had formed at the site, causing dangerous drops in blood pressure. He relied on high doses of vasoactive drugs to maintain circulation.

Doctors said any attempt at surgery carried enormous risks, including uncontrollable bleeding, vertebral artery damage and severe cerebrospinal fluid leaks. Many of the challenges had no precedent in medical literature.

Chen Huajiang, deputy director of orthopedics at the hospital, described the case as the most dangerous of his decades-long career.

"My colleagues and I reviewed extensive medical literature, but found no precedent for such a severe cervical separation case, let alone a successful treatment that allowed the sufferer to survive," said Chen, who also heads the hospital's cervical spine surgery unit.

"Various challenges during the surgery were undoubtedly unprecedented and could have potentially led to situations that are hard to manage. However, the certainty of no recovery without surgery left no other option," he said, adding that the determination of the patient's family motivated the medical team to proceed.

The surgery took place on June 18. Using advanced microsurgical techniques, the team removed the hematoma, overcame severe adhesions and deformities, and precisely realigned the severed cervical structures.

Chen said the team also applied an innovative "satellite plate" fixation technique — adding auxiliary plates to the conventional method — to provide extra stability. It was the first use of the technique in such an extreme case.

Before surgery, the team carried out a comprehensive evaluation of the injuries and drafted detailed contingency plans for possible complications such as circulatory collapse. The operation concluded within three hours without any major incidents.

Afterward, Li's condition steadily improved. After he regained consciousness, his vital signs stabilized and the tracheal tube was removed. He was able to sit up with assistance, showing signs of neurological recovery.

Li was discharged on July 9 and is now in rehabilitation to restore upper limb function.

The case has drawn wide attention in China's spinal surgery community, with experts praising the hospital's handling of the unprecedented challenge.

"Our team aims to continue expanding the frontiers of cervical spine surgery and challenging the limits of technology, offering hope to more patients facing life-threatening conditions," Chen said.