Anterior Cervical Discectomy and Fusion for Unstable Traumatic Spondylolisthesis of the Axis

Abstract

A retrospective study had been conducted to evaluate the efficacy and safety of anterior cervical discectomy and fusion (ACDF) at C2-C3 for traumatic spondylolisthesis of the axis (TSA). The present study had been done to evaluate the results and feasibility of the surgical treatment with ACDF at C2-C3, for the fixation of unstable TSA. The treatment for unstable TSA is still controversial. Anterior surgical managements of TSA used to be considered as a complex procedure with high rate of morbidity. Though some authors obtained satisfying results of ACDF for TSA, there was still no report of a relatively large series to evaluate the outcome. Since February 2001-August 2005, ACDF at C2-C3 had been performed in 30 cases of unstable TSA (Type II: 14 cases, Type IIa: 12 cases, and Type III: 4 cases, based on Levine-Edwards' classification). Arthrodesis was done by autogenous iliac graft (13 cases) or cages (17 cases). An average follow-up of 12 months was achieved (range from 6 to 48 months). Combined morbidity, operative time, days of hospitalization, complications, neurologic improvement, and fusion rate was assessed. Average operative time and hospitalization were similar to those of ACDF for lower cervical spine (102 minutes, and 9 days). No patient received blood transfusion. Plate was generally used. Axial pain was relieved in each case. The patients with preoperative neurologic deficits all got improvements. The only complication was choking and trouble in swallowing liquids in 1 case, and it diminished 3 months after operation without any treatment. No graft or plating related complication was observed. Fusion was achieved in all cases within 6 months. ACDF at C2-C3 may be a feasible and safe way to treat unstable TSA.