Post Traumatic Instability of Sub - Axial Cervical Spine - Reduction and Internal Fixation by Lateral Mass Screws : A Long Term Follow - Up Study

Abstract

AIM:We present here the clinical results of 24 patients who were operated for cervical instability following trauma by lateral mass fixation at our institution between July 2010 and Dec 2013 and to assess the stability of the construct at 2yr follow-up study. MATERIALS AND METHODS: Between July 2010 and Dec 2013 a total of 24 pts. Were operated by lateral mass fixation for cervical spine instability following trauma to subaxial cervical spine between C3-C6. Presenting with posterior element injury like facet locking and subluxation injuries were included in the study. All these patients were evaluated postoperatively for neurologic improvement, complications and Results were analyzed. RESULTS: A total of 104 screws were placed in to the lateral masses during the study. There were 8(33.3%) deaths in this series not related to the surgical procedure. There were no immediate complications related to the procedure. There was no evidence of neurovascular injury either during the procedure or immediately following the surgery. There was CSF leak in one case of badly traumatized cord injury during the procedure. Neurological improvement was seen in 13(81.2%) out of surviving 16 cases of trauma at the end of 3m to the extent of self-ambulation and the rest three did not show any improvement and remained quadriplegic. CONCLUSION: In this study we report good long term stability achieved by the lateral mass fixation with rods and screws with least morbidity and the safety of the procedure compared to other methods of posterier elements fixations. Both Roy Camille and Magerl technique can be followed for screw placement, where in Magerl technique has slight advantage of avoiding the nerve root injury and a longer screw can be placed to achieve a good bony purchase. Over all it is very safe and efficacious procedure in the hands of an experienced surgeon.