Efficacy comparison of different surgical approaches in treatment of cervicothoracic spine fractures

Abstract

Objective To investigate the efficacy of different surgical approaches in the treatment of cervicothoracic spine fractures. Methods The study enrolled 42 patients with cervicothoracic spine fractures admitted from January 2009 to January 2015. There were 30 male and 12 female patients with mean age of 45.5 years (range, 11-69 years). Involved segments were C7 in 21 patients, C7-T1 in six, C7-T2 in four, T1 in five, T1-T2 in two and T2 in four. Flection compression, flection distraction and flection burst injuries were operated through the anterior approach (27 patients), flection dislocation and over-extension injuries through the posterior approach (nine patients), and old spinal injuries, severe fracture dislocation and combined articular process locking through the combined approach (six patients). Operation time, blood loss, Japanese Orthopedic Association (JOA) score, American Spinal Injury (ASIA) score and graft fusion were observed in all patients. Results All surgeries were completed successfully. Operation time was (86.5±22.0)min and blood loss was (120.6±28.5)ml in patients undergone anterior surgery. Operation time was (145.5±27.2)min and blood loss was (584.5±45.2)ml in patients undergone posterior surgery. Operation time was (324.7±31.5)min and blood loss was (725.3±58.4)ml in patients undergone anterior-posterior surgery. Operation time and blood loss showed significant differences among the groups (F=8.461, 5.853, P<0.05). Forty patients (95%) were followed up for average 30.6 months. Bony fusion was achieved in all patients in an average of 8.5 months. At the final follow-up, all patients showed significant improvements in JOA score and ASIA score (P<0.05). Conclusions Type of injury, level of lesion and time of injury contribute directly to the selection of surgical approaches. Anterior surgical approach is performed for most flexion-type injuries. Posterior approach is recommended in patients with multi-level spinal cord injuries, articular process interlocking and bone abnormalities. Combined posterior and anterior approach is recommended for old cervicothoracic fractures. Key words: Spinal fractures; Cervical vertebrae; Thoracic vertebrae; Surgical procedures, operative