Health-related quality of life after anterior-only fixation of lower cervical spine fractures: long-term follow-up

Abstract

Background The management of lower cervical spine fractures at the cervicothoracic junction is challenging and the selection of suitable approach is a matter of debate. The results of anterior fixation of those injuries in the available literatures are ambiguous due to the heterogeneity of the studied groups and lacking long-term follow-up. Moreover, the assessment of patients’ quality of life was not taken into consideration. Our aim was to assess the health-related quality of life and long-term follow-up of a homogenous group of patients of unstable lower cervical spine fractures managed by anterior-only fixation and iliac autograft. Patients and methods Data from hospital records of 13 cases of lower cervical spine fracture managed by anterior fixation and graft were examined and analyzed. All cases were operated as the Subaxial Injury Classification (SLIC) score was greater than or equal to 5. The International Standards for Neurological Classification of Spinal Cord Injury and American Spinal Injury Association (ASIA) scores were used to assess patients’ neurologic status; segmental kyphosis angle for cervical kyphosis and short-Form 36-item was used for health-related quality of life assessment. Results Thirteen cases were included in this series with a mean age of 36.15 ± 7.82 years. C6 was fractured in 3 cases (24%), C7 in 5 cases (38%) and both C6 and C7 in 5 cases (38%). All cases have a SLIC score more than 5 with a mean of 7.0 ± 1.53 (range 5:9). The mean follow-up was 75.54 ± 22.33 months. The operative time was 90.62 ± 20.67 min The total motor score was improved from 72 ± 33.44 preoperatively to 76.92 ± 31.80 at the final follow-up. The segmental kyphosis angle was improved from 15.62 ± 3.25° preoperatively to −9.84 ± 1.77° directly postoperative and −1.30 ± 2.32° at the final follow-up and the short-Form 36-item total score was 75.04 ± 24.26. Conclusion The procedure proved to be safe and has yielded excellent results. The late patient outcome from the quality-of-life perspectives was not affected by loss of cervical lordosis, but on the contrary improved significantly in correlation with improvement of patients’ motor power.