A study on functional outcome following surgical fixation for subaxial cervical spine injuries

Abstract

Background: Cervical instability due to trauma is usually from level c3 to c7 (i.e sub axial). Neurological deficit are common i.e root compression and cord compression with subluxation and dislocation. Unstable cervical spine injuries with or without neurological deficit require open reduction. Stabilization is done by using various implants and bone grafting. Implants provide immediate stability, whereas bone grafts provide long term stability by achieving intervertebral fusion. Hence to relive from the primary impact, persistent compression and alignment of stable anatomy of cervical spine, early surgical intervention is necessary to relieve persistent compression and stabilization of subaxial cervical spine injuries. Aim of the study: To study the functional outcome following surgical fixation for subaxial cervical spine injuries involving patients who all are admitted with subaxial cervical spine injuries & amenable to intervention in our department of orthopaedics & traumatology, govt rajaji hospital, madurai from September 2011 to September 2015 Results: All the cases are male with most of the patients are in the age group of 41-50 years, Fall from height is the most common of injury followed by road traffic accident, C5-C6 # dislocation is most common spinal injury pattern. Incomplete neurological deficit are more in this study. Most of the cases are flexion distraction type of violence. Most of the cases presented with in one week of injury. Only 4 cases of 40 cases operated by global fusion, both of them are presented late and found to have locked facets. 4 out of 6 cases are expired from complete neurological deficit. Mobilisation of neck started after 6 weeks. Totally 6 cases were expired. Two cases was due to acute respiratory distress syndrome. One case due to aspiration pneumonia is. Four patients developed bed sores in which one case developed bed sore preoperatively and other postoperative lay. One patient who had grade 6 sacral sore underwent flap cover with the help of plastic surgeon intervention. Other 6 patients managed conservatively. Conclusion: The ultimate goal of surgical intervention for subaxial cervical spine injuries is stabilization of spine, restoration of spinal anatomy, decompression of neural elements, thereby promoting the neurological recovery and early facilitation of rehabilitation. In our study, we achieved a good functional outcome following surgical intervention. To conclude that early surgical stabilization of subaxial cervical spine injuries has good functional outcome, provided detailed clinical and radiological assessment, proper preoperative planning, selection of surgical approaches, precision in surgical techniques and early rehabilitation program are needed in achieving good results and minimising complications.