gms | German Medical Science

Objective: The aim of this retrospective study was to examine the primary mechanisms of injury, the surgical treatment strategies and neurological and radiographic outcome (in particular regarding the adjacent levels) after traumatic fractures of the middle and lower cervical spine.

Method: 62 of 88 (70%, mean age=36,6 years) patients with traumatic cervical spine fracture (C3-Th1, classification by Aebi and Magerl) treated operatively were examined clinically (VAS, ASIA, Frankel Score, Sickness Impact Profile Score, active and passive movement compared to normal population with the method by Dvorak) and X-Ray (ap, lateral and flexion / extension) regarding bone union and stability after 13–60 months (mean=38,4). The “Single Segment Mobility” was determined with the method by Penning.

Results: 81 of 88 patients (92%) underwent anterior stabilization after discectomy and reduction using tricortical iliac bone graft and non-angular stable plates only. 9 patients (10%) received an (additional) dorsal procedure. All cases showed good osteosynthesis, no pseudarthrosis, no screw dislocation. Comparing with the preoperative X-Ray and CT-scans 28 of 62 patients (45%) had new degenerative changes, e.g. 2 patients (3,2%) with a complete fusion of the adjacent level, 18 patients (29%) with ossification of the anterior or posterior longitudinal ligament. In 55 of 88 patients (62,5%) a complete neurological follow-up was possible, in 28 patients (51%) we saw an improvement of Frankel Score and SCIC. Severe neurological deficits (Frankel A-C) never resolved completely, but in case of early operation an improvement from Frankel A to C/D was possible in 2 cases (3,6%).

Conclusions: Anterior Stabilization with discectomy, correct reduction and stabilization with tricortical iliac bone graft and non-angular plates leads to good stability. In certain cases an additional dorsal procedure is required. Traumatic fractures of the cervical spine with neurological deficits are emergency cases and should be treated immediately, since 60% of the patients with neurological symptoms showed an improvement. After anterior stabilization we saw a significant clinical und radiographic reduction of the mobility of the cervical spine, above all in flexion / extension. Even in the adjacent level we could prove a significant reduction of the mobility after fusion, contrary to the situation in degenerative cervical spine surgery.