P123. Clinical outcome of anterior only approach for cervical fracture dislocations

Abstract

BACKGROUND CONTEXT Treatment of choice in cervical fracture-dislocation is an area of contention between anterior cervical discectomy and fusion (ACDF) and/or posterior instrumentation and fusion. Anterior cervical discectomy and fusion permits the introduction of a large graft surface area placed under compression. Also, with this approach associated cervical disk herniation can be removed and fusion can be performed in a single approach. Posterior approach is indispensable in cases associated with laminar and facetal fractures. PURPOSE The aim of this article is to analyse the clinical outcome and complications in patients undergoing anterior cervical discectomy and fusion for cervical fracture dislocations. STUDY DESIGN/SETTING Retrospective case series. PATIENT SAMPLE A total of 41 patients (25 males and 16 females) average age 46.8 years who underwent anterior cervical discectomy/corpectomy and fusion (ACDF/ACCF) with bone graft/metallic cage indicated for traumatic fracture dislocation from January 2016 to July 2018 at AIIMS, Rishikesh were included in the study. OUTCOME MEASURES ASIA scoreODI scoreVAS scoremJOA scoreNurick grading. METHODS A total of 41 patients with radiology proven unilateral or bilateral fracture dislocation included in the study were managed with planned closed reduction under general anaesthesia followed by ACDF/ACCF procedure in the same setting. All patients were followed up monthly for first 3 months and then 6 monthly till their last follow up visit and were evaluated on basis of radiological, clinical and patient reported outcomes with average follow up of 18.3 months (min 4 month, max 39 months). RESULTS Out of 41 patients (35 ACDF, 6 ACCF) 30 had complete spinal cord injury while 11 had incomplete spinal cord injury (ASIA B,C AND D). At their final follow up all showed clinical improvements in pain assessed by Visual Analog Scale (VAS) (6.8 to 1.1). Other patient reported outcomes showed significant improvement: Oswestry Disability Index (ODI) score (56.7 to 23), Modified Japanese Orthopedics Association (mJOA) score (11.5 to 17.3), Nurick's grading (4.8 to 3.4). There was no severe intraoperative complications like spinal cord/nerve root/thoracic duct/esophagus/vertebral artery injury with average blood loss of 253.1 ml. One patient of ACDF needed secondary posterior fixation in view of instability. CONCLUSIONS Anterior approach to cervical spine in cervical fracture dislocation is an effective treatment of choice showing optimal recovery rate in terms of patient reported outcomes and structural stability with added advantages of less blood loss and less instrumentation. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.