Surgical option of lower cervical spine fracture and dislocation

English Keywords:Fracture and dislocation  Lower cervical  Operation  Procedure

English Abstract:

  【Abstract】 Objectives: To explore the surgical option and clinical efficacy of lower cervical spine fracture and dislocation. Methods: A total of 32 patients including 23 males and 9 females with a mean age of 56.4 years(ranging from 28 to 78) with lower cervical spine fracture and dislocation and treated surgically from January 2007 to October 2012 was analyzed retrospectively. 22 patients suffered from neurological deficit. Based on Frankel system, 5 cases were grade A, 9 were grade B, 6 were grade C, and 2 were grade D before surgery. Surgical approaches were determined based on the type of fracture, herniated disc, spinal cord compression, facet joint locking and cervical spine injury degree. Anterior surgery was performed on 21 cases with vertebral fractures but no facet joint locking(anterior cervical discectomy or corpectomy and fusion). Posterior treatment was performed on 4 cases with facet joint locking but no significant vertebral fractures, and MRI finding of no significant pressure or flexion distraction fracture combined with bilateral facet fractures. Combined posterior and anterior approach was performed in 7 cases with vertebral fractures and disc injury associated with facet joint locking or lamina fractures, with the fracture fragments penetrating into the spinal canal. During follow-up, the neurofunction, bony fusion and spine stability were reviewed. Results: All patients underwent surgery safely without severe complications such as tracheal and esophageal injury, 4 patients were found complicated with spinal cord injury and cerebrospinal fluid leakage during operation and the wound heal after corresponsive intervention. Postoperatively, all patients were immobilized in a hard collar for 3 months. The average follow-up time was 18.5 months(range, 6-24 months). 1-2 degree of neurofunction recovery was achieved in all cases except 1 case with Frankel B. X ray verified the proper position of the screws after operation. Fusion achieved in all cases within 6 months(mean 4.5 months). There was no pseudarthrosis or nonunion occurred. The interbody height, physiological curvature and cervical stability maintained well. No instrument failure such as loosening, displacement or breakage was noted. Conclusions: Injury type, number of segment, degree of herniated disk and compression of spinal cord after cervical fracture and dislocation should be considered before surgery. Ideal operation can ensure early stabilization and neurofunction recovery.