Surgical Treatment of Lower Cervical Fracture-Dislocation with Spinal Cord Injuries by Anterior Approach: 5- to 15-Year Follow-up.

Surgical Treatment of Lower Cervical Fracture-Dislocation with Spinal Cord Injuries by Anterior Approach: 5- to 15-Year Follow-up.

World Neurosurg. 2018 Apr 06;:

Authors: Gao W, Wang B, Hao D, Zhu Z, Guo H, Li H, Kong L

Abstract
OBJECTIVE: Lower cervical fracture-dislocations are often caused by flexion-stretch injuries and frequently combine with spinal cord injuries, which can cause serious damage. To date, there is no clear consensus on the best treatment option for lower cervical fracture-dislocation. In recent years, anterior approach surgery with direct decompression and reduction has been widely accepted. However, a long-term follow-up study with a large sample size to assess the clinical efficacy of the anterior approach is rarely seen in the literature. Through this retrospective cohort study, we assessed the clinical outcomes of anterior approach surgery.
METHODS: From January 2001 to January 2011, 312 patients with lower cervical spine fracture-dislocation with spinal cord injuries who were treated by the anterior approach were retrospectively analyzed. A total of 218 cases (70%) were deemed to have integrity of data and were obtained for follow-up. The average age of the 218 patients was 42.6 years (range: 21-72), and the cases included 121 males and 97 females. All patients underwent decompression, reduction, bone grafting and arthrodesis by anterior means. The clinical efficacy was evaluated using Odom's criteria and statistical analysis based on the Cobb angle of kyphosis, the Neck Disability Index (NDI) and the Japanese Orthopedic Association (JOA) scoring system. The neurofunctional recovery of each patient was assessed by the American Spinal Injury Association (ASIA) system.
RESULTS: Follow-up for patients was for 8.9±2.9 years on average, with a range from 5 to 15 years. No loss of cervical reduction and lordosis curvature, and no plate- or screw-associated complications were observed during the follow-up. The kyphosis angle and NDI and JOA scores were significantly changed from preoperative values of 10.6±8.9°, 39.7±4.3 and 7.6±2.4 to last follow-up values of -5.2±8.6°, 10.8±4.6 and 15.6±1.2, respectively (p<0.05). Finally, 197 patients (90.4%) had good to excellent clinical outcomes, 14 patients (6.4%) had satisfactory results, and 7 patients (3.2%) had poor results. A total of 143 of the original 218 patients (65.6%) and 140 of 191 patients with incomplete paralysis (73.3%) showed varying degrees of neurological function recovery.
CONCLUSIONS: For lower cervical fracture-dislocation with spinal cord injuries, satisfactory clinical outcomes can be obtained by choosing the anterior surgical approach. By restoring the normal structure of the cervical spine and promoting functional recovery, the anterior approach achieved a good long-term curative effect.

PMID: 29631085 [PubMed - as supplied by publisher]

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