ANTERIOR STABILIZATION FOR FRACTURE-DISLOCATIONS OF THE CERVICAL SPINE

Abstract

Easier patient positioning and less extensive soft tissue dissection have spurred a trend for anterior instrumentation and fusion for C-spine fracture/ dislocations. We present group of forty-six patients treated over an eighteen month period with an anterior approach. There were no permanent approach related complications, infections, hardware failures or graft displacements. One patient had worsened post-operative neurological findings. One patient required additional posterior stabilization for a missed injury. Two patients were not reducible from the front and required posterior reduction and stabilization followed by anterior instrumentation and fusion. All grafts healed within four months of the operation.

The purpose of this study was to assess the efficacy of anterior instrumentation and fusion for Cervical Spine fracture/ dislocations

Over an eighteen month period, forty-six out of fifty-two patients with C-spine injuries requiring surgical treatment were followed prospectively. All patients underwent anterior approaches to stabilize and fuse the unstable segments using tricortical bone grafting and application of an anterior plate (CSLP, Synthes). Thirty-eight patients had single level injuries treated with discectomy and fusion. Two patients had two level discecomies. Six patients underwent corpectomy and fusions for fractures of the vertebral bodies

There were no approach related complications such as recurrent laryngeal nerve injuries, oesophageal perforations, vascular injuries or strokes. One patient deteriorated neurologically. All other patients either improved neurologically or remained with their original findings. Two patients required oral antibiotics for superficial infections at the donor site. There were no spine infections, hardware loosening or graft extrusions. All bone grafts healed within four months both clinically and radiologically. Forty-one patients complained of minor or no pain after four months. Five patients continued to have moderate discomfort. One of these patients had a missed injury above his two-level fusion with gradual progression into kyphosis requiring posterior stabilization.

Halo vest immobilization and posterior stabilization for C-spine fracture /dislocations have been the treatment of choice for many surgeons. The low complication and failure rate has spurred on a gradual change towards anterior instrumentation and fusion. Our study very strongly supports this trend. We see little indication for the more invasive posterior approach given our present results.