Anterior approach for lower cervical spine fractures and dislocations combined with spinal cord injury

English Keywords:Lower cervical spine  Fracture  Dislocation  Anterior approach  Spinal cord injury

English Abstract:

  【Abstract】 Objectives: To discuss the clinical outcome of anterior surgical treatment for lower cervical spine fractures and dislocations combined with spinal cord injury. Methods: From January 2006 to January 2011, 196 patients suffering from lower cervical spine fractures and dislocations combined with spinal cord injury in our hospital were reviewed retrospectively. 168 cases were data integrity and obtained follow-up, there were 123 males and 45 females with an average age of 38.7 years old(range, 18-71 years). 21 cases were in ASIA grade A, 46 cases in B, 60 cases in C, 41 cases in D. According to the degree of dislocation, 79 cases were in Ⅰ, 42 cases in Ⅱ, 31 cases in Ⅲ, 16 cases in Ⅳ. All cases underwent skull traction(2-4kg) before operation. And then anterior discectomy and reduction by Caspar distractor, if the reduction failed, the corpectomy was performed for further reduction. If the reduction still failed, the posterior approach was performed. Results: In this group, 148 patients(88.1%, 148/168) got reduction by anterior approach alone, the other 20 patients(11.9%, 20/168) got reduction by combined anterior and posterior approach. 151 cases(89.9%) got complete reduction, 17(10.1%) obtained reduction of more than 90%. The average follow-up time was 30.7 months. 140 patients were followed-up, 9 patients lost follow-up, and 19 patients lost follow-up due to death. All patients got bony fusion 6 months after operation. The normal disc height and lordosis were maintained. There were no plate and screw-related complications. The other complications including 4 cases suffered from hoarseness, 17 cases suffered from throat pain, 18 cases suffered from numbness in iliac region, all of them got relieved after treatment. 153 cases with neurological deficit improved significantly. Conclusions: For lower cervical spine fractures and dislocations, anterior approach can not only obtain the satisfactory reduction and immediate stability, but also prevent secondary spinal cord injury and improve the spinal cord function.