Abstract
This paper compares over an 18-month period anterior and posterior procedures in 40 patients treated surgically for dislocations and fracture dislocations of the cervical spine. Patients were followed up for a minimum of 12 months. Fifteen patients were neurologically intact, 13 were severely neurologically compromised and 12 presented with radicular symptoms. There were unifacet dislocations in 33 patients and bifacet dislocations in seven. In 23 patients there were associated fractures of the posterior elements. There was a high incidence (35%) of non-spinal injuries.
Posterior fusion (interspinous wiring) was done in 20 patients, anterior surgery (plating) in 18 and combined approaches used in two. Owing to posterior column fractures, four patients undergoing posterior surgery required two-level fusion.
Two of 13 patients with quadriplegia had useful return of function. There were no postoperative neurological complications. Reduction was successful in two of six patients who presented late (after more than 30 days) and the remaining four patients underwent an in situ fusion. In the anterior and posterior approaches operation time, blood loss, hospital stay and time to fusion were comparable. Anterior surgery without instrumentation was inadequate, but patients treated by anterior surgery had less neck and graft site pain, a lower rate of instrument failure and did not require multisegment fusion.
The anterior approach with instrumentation was safe and useful, obviating the need for two-level fusions and reducing the need for orthotic support, especially in the quadriplegic patients.
The abstracts were prepared by Professor M. B. E. Sweet. Correspondence should be addressed to him at PO Box 47363, Parklands, Johannesburg 2121, South Africa.
