Diagnosis and treatment of skipping amphi-laceration of disco-ligamentous complex combined with hyperextension injury to the cervical spinal cord

Abstract

Objective To explore the diagnosis and treatment of skipping amphi-laceration of disco-ligamentous complex (DLC) combined with hyperextension injury to the cervical spinal cord. Methods From January 2008 to December 2012, 17 cases of skipping amphi-laceration of DLC combined with hyperextension injury to the cervical spinal cord were surgically treated at our department. They were 15 men and 2 women, 21 to 57 years of age (average, 36. 3 years). Cervical spine MRI and dynamic flexion-extension lateral radiographs were performed in all patients preoperatively. Injured spinal cord segments were determined according to the plane of spinal cord injury and high signal changes in spinal cord on MRI. Segments of DLC laceration were evaluated according to cervical spine MRI and subaxial cervical stability on radiographs preoperatively. The neurological functions were graded according to the American Spinal Injury Association (ASIA) scale (version 2000) at preoperation, 3, 6 and 12 months postoperatively. The ASIA motor scores (AMS) and sensory scores (ASS) were analyzed statistically. Instrument failure and bony fusion were observed by follow-up radiographs. Results The 17 cases were followed up for an average of 28 months (from 12 to 42 months). The AMS and ASS at all postoperative time points were significantly better than those at preoperation in all patients ( P < 0. 05). Moreover, the AMS and ASS significantly improved as the follow-up time increased, with a significant difference between postoperative time points ( P < 0. 05). There was no failure of instrumentation and bony fusion was observed in all cases of bone grafting. Conclusions The skipping amphi-laceration of DLC combined with hyperextension injury to the cervical spinal cord is likely to be missed in diagnosis. The surgical procedures include decompression of the main spinal cord segment with hyperextension injury and DLC laceration and stability reconstruction of the lacerated DLC segment at the other end. Key words: Cervical vertebrae; Spinal cord; Injury; Disco-ligamentous complex