The Selection Of Surgical Approaches And Analysis Of Efficacy In Fracture And Dislocation Of Lower Cervical Spine

Objective: To explore the option and clinical efficacy of lower cervical spine fractures and dislocation. Methods: A total of 126 patients including 86 males and 40 females with a mean age of 46.4 years(ranging from 16 to 72) with lower cervical spine fracture and dislocation and treated surgically from January 2009 to September 2013 was analyzed retrospectively. Based on ASIA system, 7 cases were grade A, 48 were grade B, 54 were grade C, and 17 were grade D before surgery. Based on SLIC system, 13 cases were 4 point, 24 were 5 point, 23 were 6 point, 29 were 7 point 17 were 8 point 13 were 9 point and 7 were 10 point. According to the mechanism of injury factors in patients with spinal cord compression, morphological characteristics, location and degree of damage analysis, choice of operation scheme, of which 85 cases were treated with anterior cervical operation treatment; 12 cases had posterior operation; serious fracture dislocation of 29 cases, with combined anterior and posterior approach.Follow up of patients with neurological function, imaging evaluation to improve the degree of dislocation and bone graft fusion. Results:126 cases were successfully completed operation, No tracheal,esophageal injury,Postoperatively, all patients were immobilized in a hard collar for 3 months. The average follow-up time was 18 moths. Except 4 cases of Grade A without recovery,1cases of grade B no recovery,grading the degree of ASIA damage the rest of the patients,the average increase of 1.2grade.X ray verified the proper position of the screws after operation. Fusion achieved in all cases within 18 months. There was no pseudarthrosis or nonunion occurred. The interbody height, physiological curvature and cervical stability maintained well.No instrument failure such as loosening,displacement or breakage was noted. The score of combined approach patient almost greater than 8. Conclusion : According to the analysis of factors of lower cervical fracture dislocationinjury mechanism,specific damage morphology,location and damage degree of compression of spinal cord, Choose different operation approach, contribute to the reduction of fracture dislocation, relief of nerve compression, promote the recovery of nerve function, improve the fusion rate of bone graft. SLIC score can evaluates the severity of the fracture and dislocation,contribute to the selection of operation approach,It prompted to select combined anterior and posterior approach when SLIC score greater than 8.Reasonable selection of operation approach helps to reduce theoperation complications.