Mid- to long-term outcome of instrumented anterior cervical fusion for subaxial injuries

Abstract

The management of patients with subaxial cervical injuries lacks consensus, particularly in regard to the decision which surgical approach or combination of approaches to use and which approach yields the best clinical outcome in the distinct injury. The trauma literature is replete with reports of surgical techniques, complications and gross outcome assessment in heterogeneous samples. However, data on functional and clinical outcome using validated outcome measures are scanty. Therefore, the authors performed a study on plated anterior cervical decompression and fusion for unstable subaxial injuries with focus on clinical outcome. For the purpose of a strongly homogenous subgroup of patients with subaxial injuries without spinal cord injuries, robust criteria were applied that were fulfilled by 28 patients out of an original series of 131 subaxial injuries. Twenty-six patients subjected to 1-and 2-level fusions without having spinal cord injury could be surveyed after a mean of 5.5 years (range 16-128 months). The cervical spine injury severity score averaged 9.6. Cross-sectional outcome assessment included validated outcome measures (Neck pain disability index, Cervical Spine Outcome Questionnaire, SF-36), the investigation of construct failure and successful surgical outcome were defined by strict criteria, the reconstruction and maintenance of local and total cervical lordosis, adjacent-segment degeneration and intervertebral motion, and the fusion-rate using an interobserver assessment. Selfrated clinical outcome was excellent or good in 81% of patients and moderate or poor in 19% that corresponded to the results of the validated outcome measures. Results of the NPDI averaged 12.4 ± 12.7% (0-40). With the SF-36 mean physical and mental component summary scores were 47.0 ± 9.8 (18.2-59.3) and 52.2 ± 12.4 (14.6-75.3), respectively. Using merely non-constrained plates, construct failure was observed in 31% of cases and loss of local lordosis, expressed as a mean injury angle of 14°, postoperative angle of -5.5°and follow-up angle of -1°, was significant. However, total cervical lordosis was within the limits of normalcy (-24.3°± 13.3) and fusion-rate was 88.5%. The progression of adjacent-level degeneration was shown to be significantly influenced by a decreased plate-to-disc-distance. Adjacent-level intervertebral motion was not altered due to the adjacent fusion, but reduced in Electronic supplementary material The online version of this article

Posterior approach for cervical fracture–dislocations with traumatic disc herniation

“…In general, the surgical results of anterior cervical spine surgeries are perceived to be favorable [16,18]. However, the difficulties in reduction and in securing rigid fixation are the main drawbacks.…”

“…In general, anterior surgery is preferred for these patterns of injury, and has high rate of union and satisfactory clinical outcome [16,18]. However, there are some drawbacks to the anterior approach: there are some cases where it is difficult to reduce the displaced cervical spine only using an anterior approach, necessitating posterior reduction [21,23].…”

The state of segmental kyphosis of operated segment after anterior subaxial cervical fusion using different types of stabilizing systems

“…У літературі є відомості про те, що переломи типу В і С у віддалені терміни спричиняють вираженішу кіфотичну деформацію, ніж переломи типу А, що пев-ною мірою узгоджується з результатами проведеного дослідження [17].…”

C2-fractures: part II. A morphometrical analysis of computerized atlantoaxial motion, anatomical alignment and related clinical outcomes

“…Outcome measure included the 36-item short-form health survey (SF-36) version 2, the long-term cervical spine outcome questionnaire (CSOQ) [4] and the neck pain disability index (NPDI) [77]. The questionnaires have been validated for issues related to cervical disorders [4,23,75] and the methods for scoring as well as the interpretation of results were illustrated in detail in previous articles [23,38,44,50,75,77].…”