Treatment of combining anterior and posterior approach for lower cervical spine fracture and dislocation with difficult reduction at primary stage

Abstract

Objective To investigate the clinical effect of the treatment of combining anterior and posterior approach for lower cervical spine fracture and dislocation with difficult reduction by fixation, decompression and bone graft fusion at primary stage. Methods From January 2012 to January 2015, 32 cases patients associated with difficult reduction of articular process interlocking of the lower cervical spine fracture dislocation were treated with primary stage combining anterior and posterior approach surgical treatment, which was anterior resection of intervertebral disc decompression and posterior facet pry dial or replacement after resection, fixed, and then anterior decompression, bone graft fusion and fixation.The operation time blood loss were recorded.Whether trachea during operation, esophagus and accessory nerve injury, dural breakage of cerebrospinal fluid leakage, whether hyponatremia, whether two spinal cord injury or illness and wound healing were observed.Whether loosening or breakage of internal fixation was observed.The fusion of bone graft and whether false joint and nonunion were recorded in the follow up observation.Frankel classification, JOA score, postoperative cervical intervertebral height and horizontal displacement of vertebral body were recorded. Results The average operation time was (3.85+ 0.66) h, average intraoperative bleeding amount was (855.00+ 3.51) ml.There were no intraoperative tracheal and esophageal injury, 2 cases were intraoperative dural breakage of cerebrospinal fluid leakage and appeared 1 case of hyponatremia after surgery 5 days, but all patients were cured.Thirty-two patients were all followed up for 12 to 26 months, with average (18.00±0.55) months.Postoperative Frankel grade, 1 case of grade A, 4 cases of grade B, 7 cases of grade C, 8 cases of grade D, 12 cases of grade E. Postoperative JOA score with average (12.35±0.80) points, improvement rate of JOA score was 55.4% when discharge, postoperative cervical intervertebral height with average (7.25 ± 1.01) mm, the postoperative intervertebral level shift with average (1.22± 0.24) mm.At last follow-up, X-ray examination prompt bone grafting position were obtained bone fusion and internal fixed position good and strong. Conclusion The treatment of combining anterior and posterior approach for lower cervical spine fracture and dislocation with difficult reduction by fixation, decompression and bone graft fusion at primary stage can make the injured segment smooth reduction, early stable, decompression fully so as to improving neural function repair foundation, and also can create the conditions for lower cervical spine fracture dislocation injury rehabilitation. Key words: Joint locking; Cervical fracture and dislocation; Anterior posterior approach; Interbody fusion