Anterior surgical fixation for cervical spine flexion-distraction injuries.

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Anterior surgical fixation for cervical spine flexion-distraction injuries.

World Neurosurg. 2017 Feb 14;:

Authors: Jack A, Hardy-St-Pierre G, Wilson M, Choy G, Fox R, Nataraj A

Abstract
BACKGROUND: Optimal surgical management for flexion-distraction cervical spine injuries remains controversial with current guidelines recommending anterior, posterior, and circumferential approaches. Here, we determined the incidence of and examined risk factors for clinical and radiographic failure in patients with one segment cervical distraction injuries having undergone anterior surgical fixation.
METHODS: A retrospective review of 57 consecutive patients undergoing anterior fixation for subaxial flexion-distraction cervical injuries between 2008-2012 at our institution was performed. The primary outcome was the number of patients requiring additional surgical stabilization and/or radiographic failure. Data collected inlcuded age, gender, mechanism and level of injury, facet pattern injury, and vertebral endplate fracture.
RESULTS: A total of six patients failed clinically and/or radiographically (11%). Four patients (7%) required additional posterior fixation. Although two other patients identified met radiographic failure criteria, at follow-up they had fused radiographically, were stable clinically, and no further treatment was pursued. Progressive kyphosis and translation were found to be significantly correlated with need for revision (p<0.05 and p=0.02, respectively). No differences were identified for all other clinical and radiological factors assessed, including unilateral or bilateral facet injury, facet fracture, and endplate fracture.
CONCLUSION: This study contributes to the growing body of evidence supporting anterior fixation alone for flexion-distraction injuries. Findings suggest that current measurements of radiographic failure including segmental translation and kyphosis may predict radiographic failure and need for further surgical stabilization in some patients. Future follow-up studies assessing for independent risk factors for anterior approach failure with a validated predictive scoring model should be considered.

PMID: 28213193 [PubMed - as supplied by publisher]

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