Treatment Evaluation And Surgical Approach Selection In Lower Cervical Spine Fracture And Dislocation Combined With Spinal Cord Injury

Objective: Objective: Retrospective analysis of recent5years clinical data of thepatients in our hospital with lower cervical spine fracture and dislocation combined withspinal cord injury, to evaluate the postoperative clinical efficacy by comparing theanterior and posterior surgical approaches, and to explore the clinical choice of surgicalapproach in treating lower cervical spine fracture and dislocation combined with spinalcord injury.Methods: Collected data of80patients with lower cervical spine fractures in ourhospital from January2007to January2012, according to the inclusion criteria:preoperative X-ray, CT or MRI confirmed a fracture or dislocation of the vertebral body,combined with complex fracture intervertebral disc and ligament, spinal cord and nerveroot compression, appeared neurological symptoms and SLIC (spinal cord injuryclassification system)≥5; Exclusion criteria: screened for patients with slight stablefracture of the lower cervical spine, cervical fracture and dislocation not combined withspinal cord injury, and spinal cord injury without fracture and dislocation. Theretrospective analysis of the clinical data of56patients meeting the inclusion criteria ofthe lower cervical spine fracture and dislocation combined with spinal cord injury,according to selection of different surgical approaches, we divided them into theanterior and posterior approach groups, out of them, anterior approach group contained35patients, have the features including: anterior column injury, vertebral fracture ordislocation broke into the spinal canal, disc or posterior longitudinal ligament rupturedinto the spinal canal, fracture or dislocation accompanied with disc instability, haveanterior spinal cord compression in common. Posterior group contained21patients,have the features including: spinal column injury and annex fracture, dislocation andyellow ligament rupture protruding into the spinal canal, cause posterior compressionon the spinal cord; some patients have the rear joint dislocation, interlocking fracture and dislocation combined with cervical spinal canal stenosis and posterior longitudinalligament calcification.Recovery assessment was done by AISA injury scalerecommended by the American Spinal Injury Association and JOA spinal cord functionrecovery scoring criteria recommended by the Japanese Orthopaedic Association, apreoperative and postoperative spinal cord function improvement and recovery ratesassessment was done for the patients meeting the inclusion criteria. The two groupswere compared for the operative time and blood loss, intra-operative and postoperativecomplications, and extent of postoperative anatomical recovery, also used SUK methodto assess the postoperative interbody fusion. Data analysis was done with theapplication SPASS15.0software.Results:56patients meeting the inclusion criteria were followed up for8-24months, with an average of15.8months. Observation of treatment by two differentsurgical approaches: anterior approach group operative time:70±20min, the posteriorapproach group operation time:120±30min; so there is significant statisticaldifference (P <0.05) between two groups. Anterior group intra-operative blood loss:150±80ml, posterior group blood loss:500±180ml; there is a significant statisticallydifference (P <0.05) between the two groups. Both groups did not have anyintra-operative complications including accident injury of great vessels, trachea,esophagus and spinal cord, postoperative follow-up review of cervical X-ray showedthat both groups have obtained anatomical reduction, physiological curvature sequenceof cervical vertebrae and intervertebral height were restored. During follow-up therewas not a single case of postoperative nonunion, pseudarthrosis phenomenon, looseningof steel plate and screw, fracture and other complications. Among the two, anteriorapproach group gained strong bone fusion after12±2weeks; the posterior approachgroup took14±2weeks to get strong bone fusion, there was no significant differencebetween the two groups (P>0.05). While postoperative follow-up, some serious spinalcord injury patients (preoperative AISA classification: A grade5cases, B grade3cases)did not have significant improvement of the spinal cord nerve function, but symptomsof upper extremity numbness and radiating pain were eased at varying degrees. Afteroperative treatment, rest of the patients in the two groups improved an average of1-2grades of AISA injury scale as compared with the preoperative grades, among them, theanterior approach group improved an average of of1.5, while the posterior groupimproved an average1.3, the difference between the two groups was not statistically significant (P>0.05). JOA spinal cord function recovery score: anterior approach groupof35patients had preoperative average score:6.5±3.5points, posterior group of21patients had preoperative average score:6.5±3.2points, before surgery two groups didnot have significant difference (P>0.05); while follow-up12months post-operation,anterior approach group average score:12.8±3.6points, posterior approach groupaverage score:12.8±3.4points, as compared to pre-operation,12monthspost-operation score increased significantly (P <0.05).12months post-operative,anterior group improvement rate:70.5±15.6%, posterior group improvement rate:68.4±13.2%, the two groups do not have significant difference (P>0.05).Conclusion: Application of anterior or posterior surgical approach for treatment oflower cervical fracture and dislocation combined with spinal cord injuries can stabilizethe injured segments and do anatomic reduction satisfactorily, spinal nerve function canget a good recovery. But the individualized choice of surgical approach is the key tosuccessful operation which needs to be based on the patient’s type of injury, the locationof injury, and the site of spinal cord compression.