Treatment of Subaxial Cervical Spinal Injuries (original) (raw)
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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.
Management of unstable thoracolumbar spinal injuries by posterior short segment spinal fixation
International Orthopaedics, 2007
Fifty patients with thoracolumbar fractures were treated operatively between July 2000 and December 2001. The average age of the patients was 33.6 years (range: 20-50 years), 36 were males and 14 were females and the follow-up averaged 59 months (range: 49-68 months). A fall from a height, usually a tree, was the most common cause of injury. Twenty six patients had unstable burst fractures and 13 had translational injury. There were 15 patients with complete neurological deficit, 17 had partial neurological lesions, while 18 had no neurological deficit. All patients were treated by posterior short segment fixation (Steffee VSP). The average pre-operative kyphotic angle was 21.48°, which improved to 12.86°in the immediate post-operative period. The loss of kyphosis averaged 3.46°(0-26°) at the final follow-up. The average pre-operative anterior vertebral body height was 44.7% (range: 36-90%), which improved to 72.0% (range: 55-97%) in the immediate post-operative period. The loss of body height averaged 3.0% (range: 1-15%) at the final follow-up. No neurological deterioration was seen, and in 24 cases a one grade or better improvement was observed. The mean pain score was 1.6, and the mean functional score was 2.8. We found that the application of posterior instrumentation resulted in a reasonable correction of the deformity with a significant reduction in recumbency-associated complications; there were, however, significant other complications. Résumé Cinquante patients présentant une fracture thoracolombaire ont été traités entre juillet 2000 et décembre 2001. L'âge moyen était de 33.6 ans (20 à 50). Il s'agissait de 36 hommes et 14 femmes. Le suivi moyen était de 59 mois (49 à 68). La chute d'une hauteur habituellement d'un arbre était la cause la plus connue. Vingt-six patients avaient une fracture instable et 13 un traumatisme avec translation. Quinze patients avaient un déficit neurologique complet, 17 un déficit neurologique partiel et 18 aucun déficit neurologique. Tous les patients ont été traités par une fixation postérieure (Steffee VSP). L'angulation sans cyphose préopératoire a été de 21.48°en moyenne, celle-ci s'est améliorée de 12.86°en postopératoire immédiat. La perte de cyphose a été de 3.46°(0-26) au suivi final. La hauteur vertébrale de 44.7% (36-90) s'est améliorée à 72% (55 à 97) en postopératoire immédiat. La perte de hauteur du corps vertébral a été de 3%
INTERNATIONAL JOURNAL OF SCIENTIFIC RESEARCH, 2020
Advances in perioperative care, surgical instrumentation, and understanding of the patho-physiology of trauma have engendered new treatment paradigms for these injuries within the last two decades. Evaluation of outcome of LATERAL MASS FIXATION in sub-axial cervical spine injury in terms of improvement of neurological deficit (ASIA Scale) in one, three, six and nine months follow up. Sub-axial cervical spine injury patients attending OPD, Emergency. Age group: between 15 to 75 years, both male and female. The study was a both retro and prospective, non randomized, uncontrolled, interventional study group. The study was performed over a cohort of adult patients. Our study attested to the safety and acceptability of lateral mass fixation as a established mean of posterior fixation with no failure rate after one year follow up and a lesser operative complication rate.
Management of cervical spine injury
Baillière s Clinical Anaesthesiology , 1999
Field assessment, neck immobilization, oxygenation and maintenance of the airway occur in suspected cervical-spine-injured patients before transport to a regional spinal cord injury centre. After cervical spine radiography, bony alignment of the spinal column is re-established and mean blood pressure is maintained at 80±90 mmHg with ¯uids and, if necessary, inotropic support. Predetermined guidelines are used for intubation and ventilation and for invasive monitoring of patients in spinal shock. Fluid challenge is used to assess reserve cardiac function and the need for ¯uid infusion, restriction or inotropic support. Evoked potential monitoring provides a non-invasive, objective and sensitive method to assess neuroconduction through a spinal cord injury and may be used to replace a wake-up test intraoperatively. There are no randomized prospective studies showing that surgical decompression and/or internal stabiliza-tion improves outcome compared with non-surgical treatment of acute cervical spine injury. Respiratory failure is managed by long-term ventilator support, diaphragm pacing or use of glossopharyngeal breathing. Chest physiotherapy is helpful in reducing the occurrence of atelectasis and pneumonia. Hyperre¯exic syndromes during surgery are avoided with adequate anaesthesia during stimulation. An area with a population near one million should designate a regional spinal cord injury centre. Such centres decrease the proportion of patients with complete neurological injury. The diagnosis and acute management of cervical spinal cord injury (SCI) can be divided into six separate phases: (1) initial assessment and immobilization; (2) resuscitation and medical management; (3) radiological diagnostics; (4) anaesthesia management; (5) surgical therapy; and (6) post-operative critical care management.
The Management of Cervical Spine Injuries – A Literature Review
Orthopedic Research and Reviews, 2021
Due to the inherent bony instability of the cervical spine, there is an over-reliance on ligamentous structures for stability, making this segment of the vertebral column most prone to traumatic injuries. The frequently occurring mechanisms of injury include axial compression, hyper-flexion, hyper-extension, and rotational type injuries. Good pre-hospital care and a thorough assessment in the emergency department of patients suspected to have a cervical spine injury (CSI) leads to improved clinical outcomes. The objective of the initial evaluation of a patient with a suspected CSI is to identify the presence of injuries through thorough clinical and radiologic assessments as missed injuries are potentially catastrophic. The treatment of cervical spine injuries can be conservative, pharmacological, or surgical, and aims to halt SCI progression, stabilize the spine, and to allow rehabilitation of the patient.
Global spine journal, 2018
Expert consensus. To establish treatment recommendations for subaxial cervical spine injuries based on current literature and the knowledge of the Spine Section of the German Society for Orthopaedics and Trauma. This recommendation summarizes the knowledge of the Spine Section of the German Society for Orthopaedics and Trauma. Therapeutic goals are a stable, painless cervical spine and protection against secondary neurologic damage while retaining maximum possible motion and spinal profile. The AOSpine classification for subaxial cervical injuries is recommended. The Canadian C-Spine Rule is recommended to decide on the need for imaging. Computed tomography is the favoured modality. Conventional x-ray is preserved for cases lacking a "dangerous mechanism of injury." Magnetic resonance imaging is recommended in case of unexplained neurologic deficit, prior to closed reduction and to exclude disco-ligamentous injuries. Computed tomography angiography is recommended in high-g...