ABSTRACT
Objective To investigate the clinical effect and value of applications on different surgical treatments of unstable fracture and dislocation of the lower cervical spine combined spinal cord injury. Methods From January 2008 to December 2011, 110 cases of unstable fracture and dislocation of the lower cervical spine combined spinal cord injury patients who underwent surgical reduction, decompression, stabilization and fusion were divided into three groups with different operations: anterior group of 40 cases, posterior group of 22 cases, coadunation group of 48 cases. Preoperative Frankel grade: A-class of 12 cases, B-class of 17 cases, C-class of 30 cases, D-class of 38 cases, E-class of 13 cases. The average Cobb angle, sliding distance between vertebral body and Japanese Orthopaedic Association (JOA) scores before operation and after operation were compared. Results All the patients were followed up for 6 -24 months, the averaged period was 16 months. Solid fusion were obtained in all the cases at 4.3 months post-operative. There were no vascular, nervous, esophagus or spinal cord iatrogenic injury complications during the operation. There were no pseudarthrosis, bone nonunion or bone resorption, and there was no complications related to internal fixation breakage, loosening or displacement. One or two degree of Frankel grade recovery was achieved after surgery. The average Cobb angle, sliding distance between vertebral body and JOA scores in three group after operation were significant improved than those before operation (P<0.05). The JOA scores in coadunation group was significantly higher than that in anterior group and posterior group:(15.8±3.7) scores vs.(13.8±5.6), (14.2±3.5) scores, P<0.05. Conclusions One-stage anterior-posterior approach surgery is an ideal choice for unstable fracture and dislocation of the lower cervical spine combined spinal cord injury, for it provides unlocking reduction, canal decompression, and rigid reconstruction of the anterior-posterior column.It is benefit for the functional recovery of the spinal cord. But the risk increased, according to patient' s conditions carefully choose surgical options.