A Mechanistic Based Analysis of Clinicoradiological and Functional Outcome in C7-T1 Translational Injury

Abstract

C7-T1 translational injuries are relatively rare, unstable, and usually associated with neurological impairment. We aim to analyze the C7-T1 translational injury based on Allen and Ferguson's classification and to highlight the clinicoradiologic and neurologic outcomes in these patients. Patients with C7-T1 translational injury were retrospectively analyzed and demographic data, mechanism, mode of injury, surgery details, and associated injuries were obtained. The initial neurologic status was recorded as American Spinal Injury Association (ASIA) grade. All the injuries were classified as per Allen and Ferguson classification and stage 4 compressive extension (CE) injury was further classified into stage 4a and stage 4b according to Rebich etal. Among 44 patients, the most common mechanism of injury was CE injury seen in 27 patients (61.4%) followed by distractive flexion (DF) in 16 patients (36.4%) and compressive flexion in 1 patient (2.2%). Neurologic deficit was noted in 14 of 27 patients (51.85%) with CE injury, which was less compared to 12 of 16 patients (75%) with DF injury. However, there was no significant difference in terms of neurologic recovery. One patient with standalone anterior fixation had implant loosening and underwent additional posterior fixation. We present the largest series of C7-T1 translational injuries in the literature to our best knowledge. CE injury is nearly 2 times more common than DF injury and is associated with a lower incidence of neurologic deficit and easier fracture reduction techniques. Staging the injury severity aids in better planning in terms of surgical approach and levels of fixation.