Treatment of severe cervical spine injuries by anterior interbody fusion with early mobilization (original) (raw)
Related papers
The impact of fusion on adjacent levels in cervical spine injuries
Objective: Although the literature on degenerative disease of the cervical spine contains numerous articles studying the changes on levels adjacent to a fusion, there exist very few such studies concerning cervical spine stabilization for trauma. Methods: Over a 16-year period (1989)(1990)(1991)(1992)(1993)(1994)(1995)(1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005), one hundred and twelve patients underwent stabilization of the lower cervical spine (C3-T1) for subaxial cervical spine injuries, either with an anterior or posterior procedure, or both. Eighty-one patients with adequate follow-up were included in the study and 3 groups were identified: Group A, consisting of 8 patients who underwent anterior stabilization and developed Adjacent Level Ossification Development (ALOD), Group B, comprising 53 patients who were anteriorly plated but who did not develop ALOD and Group C, comprising 20 patients who received posterior stabilization. Results: Eight out of 61 patients (13.1%) who were anteriorly operated developed ALOD in 11 adjacent levels (Group A). Severe (grade 3) ossification was noted in 6/8 patients at the cranial adjacent level, and in 2/8 patients at the caudal one. Three out of 8 patients presented with early ALOD at 3, 4 and 18 months respectively. Despite the radiographic abnormalities showing ossification, all the patients had an uncomplicated course without symptoms. All the radiographs of Group B and Group C patients demonstrated grade 0 ossification for both the cranial and caudal adjacent levels. Conclusion: Adjacent-level ossification in cervical spine injuries may appear very early in the postoperative period and it can have a different course than in the degenerative disc disease population, at least in some patients. The first cephalad level adjacent to a fusion appears to be at greater risk. However, even when ALOD is evident radiographically, it very rarely produces any symptoms.
Abstract: Objectives: The aim of this report is to establish the efficacy of anterior cervical decompression fusion (ACDF) in patients with traumatic lesions of the middle and lower segments of the cervical spine. The goals of surgical treatment are: maintenance of neurological function, prevention of additional functional loss and restoration of spinal stability with bony fusion Materials and methods: Between 2007 and 2014, a total of 35 patients (27 male and 8 female) with a mean age of 48 (aged between 18 and 78 years) with trauma to the middle and lower cervical spine were treated in our clinic. The operative levels were C3-C4 in 3 patients, C4-C5 in 7 patients, C5-C6 in 15 patients, C6-C7 in 9 patients and C7-D1 in 1 patient. The preoperative degree of neurological deficit was evaluated with Frankel scale. According to the Frankel scale, 4 (11.4%) patients were grade A; 6 ( 17.1%) were grade B, 5 (14.3%) were grade C, 8 (23%) were grade D and 12 (34.2%) patients were grade E. The average preoperative VAS was 8. The majority (30 of 35 patients) were investigated with MRI scan. All patients underwent ACDF using a Peek cervical cage and titanium plate fixation, and in 11 cases the operation was performed after application of cervical traction. The follow-up period ranged from 12 to 24 months with clinical and radiological evaluation. Results: After the ACDF, 4 (11.4%) patients with complete lesion cord remained unchanged; 4 (11.4%) were grade B, 3 (8.6%) were grade C, 10 (28.6%) were grade D and 14 (40%) patients were grade E. Of patients with E grades, 5/14(36%) had isolated radiculopathies; 3/5(60%) patients recovered totally and the neurologically intact patients remained unchanged. The mean postoperative VAS at the latest follow-up was 2. The follow-up showed good clinical and radiological outcome and body fusion. For 32 patients, the follow-up was at 24 months. In this group, fusion occurred in 31/32 patients (97%) (Fig 2-4). No wound complications or infection were present. Conclusion: Our study shows that ACDF with fusion and titanium plate fixation can be considered a safe and effective technique to restore the stability of traumatic lesion of middle and lower cervical spine.
Is Anterior-Only Fixation Adequate for Three-Column Injuries of the Cervical Spine?
Asian Spine Journal
To analyze the clinical and functional outcomes of patients who have undergone anterior cervical discectomy/corpectomy and fusion (ACDF/ACCF) for a three-column cervical spine injury (CSI). Overview of Literature: The treatment of choice for a three-column CSI is an area of contention; however, combined anterior and posterior fixation is the preferred method explored in the literature. Studies have shown the superior biomechanical stability of posterior fixation over that of anterior fixation, but anterior-only approach in CSI has been proving its efficacy in recent times by providing reasonable stability with the maximum achievable decompression and fusion. Methods: Twenty-one patients undergoing ACDF/ACCF with a bone graft/metallic cage treatment for cervical injuries involving all three columns from January 2016 to July 2018 were included in the study. All of the patients were followed up monthly for the first 3 months and then every 6 months, until their last follow-up visit. Results: Nineteen patients had AO type C injuries and were managed with ACDF, and two patients with AO type B injuries were managed with ACCF. Fifteen had a complete spinal cord injury, while six had an incomplete spinal cord injury (American Spinal Injury Association B, C, and D). The mean segmental kyphosis at presentation of 12.2°±4.4° improved in the postoperative period to-7.2°±2.5°. At their final follow-up, all the patients showed clinical improvements when assessed by the Visual Analog Scale (6.8-1.8), Oswestry Disability Index score (59.7-34.9), and Spinal Cord Independence Measure score (24.8-36.4). One patient in the ACDF group needed a secondary posterior fixation because of instability. Conclusions: An anterior approach to the cervical spine in cervical fracture dislocations is an effective treatment showing an optimal recovery rate in terms of patient-reported outcomes and structural stability, with the added advantages of less blood loss and the fact that the technique requires less instrumentation.
Spinal Cord Series and Cases, 2018
Study design Single-center, retrospective case-control study. Objectives This study aimed to determine the risk factors for progression of neurological symptoms after anterior fusion for cervical spine trauma with no or incomplete spinal cord injury. Setting Community-based hospital with an acute care center in Japan. Methods We retrospectively reviewed 54 consecutive unstable subaxial cervical spine fracture/dislocation cases that had undergone surgical treatment. A total of 20 patients with no or incomplete spinal cord injury who underwent anterior fusion were identified. Injury characteristics, bony spinal canal diameter (SCD) at the injured level on computed tomography (CT), diagnosis delay of more than 24 h, and other surgery-related parameters were documented as potential risk factors. Results The study population included 16 male and 4 female patients. The median age was 71.5 (range: 20-88) years. Two cases of SCI progression were identified (AIS E to C5-8 C and AIS D to C5-8 C). Both cases occurred in men who were older than the average age of all the patients. Only delayed diagnosis was significantly associated with the progression of SCI (p = 0.02). SCDs on CT demonstrated a tendency to be smaller than those of cases without progression, but this was not statistically significant (progression: median, 8.1 [7.2-8.9] mm; no progression: median, 10.1 [4.2-12.6] mm; p = 0.21). Conclusion Our results suggested that a delay in diagnosis was associated with neurological progression after ACF. Furthermore, imposing ligamentous flavum might become a compression factor if the diagnosis is delayed.
Single Stage Global Fusion for Fracture Subluxation of Cervical Spine Injury-Case Report
ABSTRACT Introduction: Fracture subluxation following cervical spine injury is commonly encountered. Fracture subluxation can result in a serious spinal injury due to compression of the spinal cord. Though decompression of spine is done either anterior or posterior depending upon the site of compression, there is no consensus regarding the stabilization of spine either anterior or posterior or both after decompression of the spinal cord. Global fusion involves combined anterior and posterior stabilization of cervical spine. We report a case of fracture subluxation of C6 over C7 vertebra for whom global fusion was done in a single stage to prevent neurological deficit. Thirty six year old male patient who was a construction worker was brought to casualty after history of fall from height of 20 feet. Patient was immediately immobilized with Philadelphia collar and examined clinically for neurological deficits. On examination patient had no motor weakness and had hypoesthesia in C8 dermatome bilaterally. Radiological examination was done and patient was taken up for surgery. Global fusion following decompression was done for the patient. Anterior decompression with bone grafting and anterior cervical plate fixation followed by posterior stabilization with interspinous wiring and bone grafting was done. Postoperative period was uneventful. Patient recovered from hypoesthesia and immediate mobilization was started. Conclusion: The combined single-stage anterior and posterior stabilization procedure represents a viable option in the treatment of patients with fracture subluxation following cervical spine injury than with single anterior or posterior approach alone. Keywords: Cervical fracture subluxation, single stage global fusion, cervical spine injury
International Journal of Orthopaedics Sciences, 2022
Introduction: Cervical spine injuries represent 2 to 6% of adult blunt trauma, and one third of all spinal injuries. Anterior approach of operative management of cervical spinal injury with incomplete neurological lesion has least analyzed in our settings, the present study has been designed to evaluate the outcome of ACDF and stabilization by cervical plate and screw for managing traumatic cervical spine injury with incomplete neurological deficit. Methods: This study was conducted at NITOR, Dhaka, from July 2016 to June 2018.Twenty available patients meeting the inclusion & exclusion criteria were included. All cases were properly evaluated preoperatively and underwent ACDF & stabilization with cervical plate and screws. Follow up was done for 5 to 12 months. The final assessment was done by ASIA impairment scale, MRC grading, Bridewell fusion grade, Denis work & pain scale and modified Odom's criteria. Results: Highest number of patients 10 (50%) were in ASIA grade B, 7(35.0%) patients were in ASIA grade D and 3(15.0%) patients were in ASIA grade C on admission. But in last follow up, highest number of patients were in ASIA grade E (45%). The ASIA grade has improved 1 grade in 55% cases. Bridewell fusion grade showed anterior fusion grade I in 55% of cases, grade II in 45% cases. 60% of cases were in W2 group of Denis work scale after last follow up. Early post-operative complications were dysphagia (20%), respiratory distress (5%) and neck pain (20%). Late post-operative complications were neck pain (10%), donor site pain (5%) and bed sore (5%). According to modified Odom's criteria, 65% of the cases were found excellent. Conclusion: On the basis of the results in this study, it can be said that anterior cervical decompression, stabilization and fusion by bone graft of the patients who have traumatic unstable cervical spine injury with incomplete neurological lesion will provide effective benefit.
Clinics and practice, 2012
Intervertebral fusion through an anterior approach with polymethylacrylate is a well-established neurosurgical technique in the treatment of cervical spine degeneration. However, questions still remain concerning the post-surgical outcome. Factors influencing surgical outcome that could help to predict which patients need further post-surgical treatment and what to expect after surgery are the subject of numerous studies. In the present study, we retrospectively collected data from patients who had undergone intervertebral fusion and defined which pre-operative factors could influence the surgical outcome. Between 1993 and 1997, 379 patients were surgically treated with the ventral fusion technique in our hospital. In 2006, we sent a questionnaire to the patients and 164 responses were received. We identified pre-operative presence of severe pain, hypesthesia, palsy and gait disturbance as negative predictive factors, whereas age, body mass index, pre-operative physical strain and t...