ABSTRACT
STUDY DESIGN: A retrospective clinical and radiological analysis. OBJECTIVES: To evaluate the availability of anterior cervical plating in the treatment of distractive-flexion injuries of the lower cervical spine. SUMMARY OF LITERATURE REVIEW: Surgical approaches for distractive-flexion injuries of the lower cervical spine have included the anterior approach, the posterior approach, and the combined anterior and posterior approach. However, which approach is the most useful remains a controversial issue. MATERIALS AND METHODS: We reviewed the outcomes of 30 patients, who were followed-up for an average of 16 months (range, 12-43 months) after undergoing fusions with anterior cervical plating for distractive-flexion injuries of the lower cervical spine from July 1995 to July 2004. The average age of these patients was 52.9 years (range 24-77 years) and male-to-female ratio was 26:4. Group A consisted of 19 cases that were composed of unilateral dislocations and Group B consisted of 11 cases that were composed of bilateral dislocations based on Allen s classification. Group A1 (9 cases) and B1 (8 cases) were composed of cases that had fractures on the superior end plates or facet joints of the lower cervical spine in each group. Group A2 (10 cases) and B2 (3 cases) were composed of cases without fractures in each group. Neurologic symptoms were evaluated by the Frankel classification; and the angle of lordosis, disc height, and duration of bony union were analyzed postoperatively and with the last follow-up roentgenograms. RESULTS: Clinically, 22 (73%) patients had neurologic deficits, which were composed of 9 (41%) cases of complete injury, 7 (32%) cases of incomplete injury, and 6 (27%) cases of nerve root injury. The nerve root injuries recovered in all cases and the incomplete injuries had an average 1.7 grade recovery by the Frankel classification. Radiologically, the loss of lordosis was 2.2+/-1.7degrees in group A, 3.1+/-2.8degrees in group B (p=0.359), 3.0+/-1.6degrees in group A1, 1.5+/-1.5degrees in group A2 p=0.048), 3.5+/-3.1degrees in group B1, and 2.1+/-1.7degrees in group B2. Loss of disc height was 1.7+/-1.1 mm in group A, 2.2+/-0.9 mm in group B( p=0.201), 2.2+/-0.9 mm in group A1, 1.2+/-1.0 mm in group A2 (p=0.046), 2.5+/-0.6 mm in group B1, and 1.2+/-1.1 mm in group B2. The duration for bony union was 12.9+/-2.8 weeks in group A, 14.1+/-2.7 weeks in group B (p=0.044), 13.9+/-2.1 weeks in group A1, 11.9+/-3.0 weeks in group A2 (p=0.046), 14.4+/-2.9 weeks in group B1, and 13.3+/-2.3 weeks in group B2. There was no graft displacement, nonunion or metal failure. CONCLUSION: Anterior cervical plating was an effective treatment modality for distractive-flexion injuries of the lower cervical spine. and more firm method was necessary to surgical treatment in case of fractures on superior end plate or facet joint.
Subject(s)
Animals , Humans , Classification , Joint Dislocations , Follow-Up Studies , Lordosis , Neurologic Manifestations , Retrospective Studies , Spine , Transplants , Zygapophyseal JointABSTRACT
No abstract available.
ABSTRACT
As Kelsey stated “Four out of five individuals will have a significant complaint of back painat one time or another in their lives and impairment of the spine are the most frequent cause of time lost from work”., low back pain affects the quality of life for just about everyone, medical and economic impacts of low back pain are enormous. Nevertheless, neither the government not industry has been seriously involved in the study of the cause, prevention, and management of back pain. The purpose of this study was to review and analysis the clinical materials of low back painand draw differences, if any, between discogenic and stenotic low back pain. Three hundreds and fourty nine cases suffering from low back pain and/or sciatic pain, excluded fresh traumatic and inflammatory conditions of the spine, have been admitted and treated at Dept. of orthopaedic surgery, Eul-Ji General Hospital, Dae-Jeon from May, 1981 to April, 1984. They were consisted of H.N.P. (172 cases), Spinal stenosis (61 cases), Spondylolisthesis (42) cases), Degenerative joint Disease of the spine (48 cases), and Others (26 cases). Among them, two hundred and twenty six cases who were followed more than four months were mainly subjectecl to this study.