Choice of surgical approach for distraction-flexion injury to the lower cervical spine

Abstract

Objective To retrospectively compare the clinical results of 3 surgical approaches used in the treatment of distraction-flexion injury to the lower cervical spine. Methods Included in this analysis were 30 patients who had been treated surgically for a distraction-flexion injury to the lower cervical spine from August 2002 to August 2008. Seven of them were treated through anterior approach, 5 through posterior approach, 11 through posterior-anterior approaches and 7 through anterior-posterior-anterior ap-preach. The different approaches were compared in terms of changes in transverse displacement and Cobb angle, neurologic recovery (Frankel criteria), fusion time, fusion rate, surgery time, and complications.Results The mean follow-up was 8 (5 to 24) months. Bone fusion was obtained in all patients. No plate or screw loosening occurred. The mean Frankel score increased from 1.67 preoperatively to 2.22 postopera-tively. The mean Cobb angle was 7.78° before operation and 1.79° after operation, and the transverse dis-placement was 3.67 mm before operation and 0.53 nun after operation. The combined anterior and posterior approach resulted in significantly longer operation time and more blood loss than either the anterior or the posterior approach alone (P 0.05).Conclusion Since all the different approaches can lead to satisfactory results, the choice of surgical ap-proach should be based on the conditions of dislocated facet joint, reduction and injury of the disc. Key words: Cervical vertebrae; Wounds and injuries; Surgical procedures; operative; An-terior approach; Posterior approach