The value of fibular intersomatic fusion in the treatment of recent cervical spinal cord injuries.

Abstract

A Series of six patients with recent cervical spine fracture and spinal cord injury treated by corpectomy and fibular strut graft is presented. Three patients had a complete sensorimotor tetraplegia and the other three had an incomplete sensory but complete motor lesion. All patients had fractures of one or two adjacent vertebrae with concomitant displacement which was corrected by skull traction prior to surgery. Gas myelography in three patients revealed herniated disc material in two instances. Corpectomy and fusion were carried out on the 12th, 13th, 29th, 32nd, 33rd, and the 58th post-traumatic day. There was no immediate mortality or major complication associated with the procedure. One late death in an elderly patient 6 months post-operatively is felt to be unrelated to the procedure. In this series gas myelography was carried out at a later date following the injury. The goal of the operation was therefore not primarily to decompress the cord but to stabilise the fractured spine in order to allow earlier mobilisation than traditional treatment in traction. Average time out of bed was 9 days post-operatively and 36 days post-injury. Solid fusion sufficient to allow discontinuation of all neck support was achieved in 3 months in all patients. There were no episodes of graft displacement or dislocation and in only one patient was there a moderate increase in angulation at the fracture site. In the patient who died 6 months postoperatively gross and histologic examinations showed incorporation and union at the ends of the graft and bridging of the injured area by new bone. The authors feel the above procedure in selected patients—six out of 62 patients admitted with cervical spine and spinal cord injury within 4 weeks of trauma during the past 39 months—is an important adjunct to the treatment and rehabilitation at their spine fracture and spinal cord injury.