Intubación orotraqueal a través de mascarilla laríngea Ambu AuraOnceTM en paciente con lesión de médula espinal cervical / Orotracheal intubation through Ambu AuraOnceTM laryngeal mask in patient with cervical spinal cord injury

Resumen: Reportamos el manejo exitoso de la vía aérea con intubación orotraqueal a través de una máscara laríngea AuraOnceTM en un paciente con lesión de la médula espinal cervical. Su uso fue como dispositivo de rescate de la vía aérea tras intubación orotraqueal fallida con laringoscopía directa y dificultad para la ventilación con mascarilla en una paciente traumatizada de 46 años. Se tomó la decisión de utilizar la mascarilla laríngea sin intubación como conducto para la colocación de un tubo orotraqueal, lo cual se realizó con éxito. Este uso alternativo de la mascarilla laríngea Ambu AuraOnce podría ser de gran valor para los trabajadores de la salud en países de escasos recursos donde los dispositivos avanzados para las vías respiratorias no están fácilmente disponibles.

Abstract: We reported a successful airway management in a patient with a diagnosed cervical spinal injury with a non-intubating laryngeal mask AuraOnceTM. Its use was as a rescue airway device after failed orotracheal intubation with direct laryngoscopy and difficulty with facemask ventilation in a 46-year-old trauma patient. The decision was made to use the non-intubating laryngeal mask as a conduit for the placement of an orotracheal tube, which was done successfully. This alternative use of the Ambu AuraOnce laryngeal mask could be of great value to healthcare workers in resource-poor countries where advanced airway devices are not readily available.

Multiple Grade IV Pressure Injuries in a Young Boy: A Look Into the Pathognomic and Management of Iliac Crest Pressure Injury

Pressure injury (PI) not only exerts a physical burden on a patient’s body but also adds to his mental and economic stress. We, hereby, present a case report of a 17-year-old boy, who sustained a cervical spine injury after a road traffic accident, 10 months back, and later developed multiple pressure injuries over the bilateral trochanter and the left ilium. We discuss the pathognomic of the occurrence of PI at unusual sites like the ilium and our management for coverage of such defects.

Epidemiological study of cervical spine injury in a tertiary care center in South India

Background: Cervical spine injuries, according to severity can leave victims with long standing neck pain or varying degrees of weaknesses. The purpose of this study is to determine the epidemiological pattern of cervical spine injury in our hospital so that comparison may be made with other institutions and guidance regarding management may be formulated for the betterment of patients.Methods: This cross-sectional longitudinal study was conducted in Government Medical College, Thiruvananthapuram and included all patients admitted with clinical or radiological evidence of cervical spine injury, over a period of three months.  Semi-structured questionnaire was used to collect socio demographic data and details regarding mechanism of injury. Data was analyzed using SPSS.Results: Out of 452 patients enrolled, 69.7% were males and 30.3% were females. Patients were the most commonly between 30-60 years of age (52.4%). Majority (56.1%) had hospital stays lasting less than 10 days. Most common mechanism of injury was road traffic accidents (46.6%). Neck pain was the most common symptom and cervical spine straightening was the most common radiological abnormality. The severity of injuries was more severe in patients who were not restrained by seat belt or using a helmet.Conclusion: Road traffic accidents are the most common cause for cervical spine injuries and majority of patients required only symptomatic care.

​A Comprehensive Study of Deaths due to Cervical Spine Injuries in Various Cases Reported at a Tertiary Care Hospital Mortuary during the Period of January to December 2015

Introduction: The cervical spine is made up of the first 7vertebrae, referred to as C1-7. It functions to provide mobilityand stability to the head while connecting it to the relativelyimmobile thoracic spine. A cervical spinal injury makes aperson morbid and it is the most crippling disease and themost common cause of spinal cord injuries are motor vehicleaccidents. Hence, the aim of the present study was to assessthe anatomical distribution of cervical spine injuries and drawa parallel with mortality and to study cervical spine injuries inrelation to variety of trauma.Material and methods: The present study was conductedamong 93 cases which were obtained from sample sizecomprised of all cases with cervical spine injury autopsiedat medico legal center between January to December 2015.The cases for study included wherever the cervical spinewas traumatically injured alone or in combination with otherinjuries.Results: A total of 5240 cases were autopsied at medico legalcentre of which 93 cases had clear demonstrable cervicalspine injuries. Of the 93 cases 68 cases are identified bodiesand 25 are unknown. Total number of cases is 93 out of which87 were males and 6 were females.Conclusion: It was found that the mortality due to cervicalspine injury comprised 1.77% of all cases. Majority ofvictims were males with female ratio 87:6. Common agegroup involved in the study was 31-40 years. Accidental casescomprised 74% of all cases and the rest 26% were suicidalcases.

The Effect of Novel Ballistic Helmet Weight on Cervical Spine Injury under Bullet Impacts / 医用生物力学

Objective To establish a valid human head-neck model and ballistic helmet model, and analyze biomechanical responses of the cervical spine under bullet impacts on ballistic helmet with different weights. Methods A uniformly distributed weight of 2 kg was applied on the helmet (1.24 kg), and bullet impacts from frontal, lateral and crown directions at the speed of 450 m/s were considered to obtain the mechanical response of human vertebrae. Results The stress of the cervical spine was significantly higher than that of the skull under bullet impacts, and the stress of C3 segment was the largest, indicating that the cervical spine was more vulnerable than the head during bullet impacts under the protection of ballistic helmet. When the weight of helmet attachment was not considered, the maximum stress of the cervical spine under lateral impact was 2.58% higher than that under frontal and crown impacts. The frontal impact led to the greatest damage to the head, with an increase of 59.4% in head stress. When the weight of helmet attachment was considered, a lager helmet weight would cause a more serious spine injure. When the helmet weight was increased from 1.24 kg to 3.24 kg, the crown impact led to the greatest damage to the cervical spine, with an increase of 12.98% in cervical stress compared with impacts from other directions. Conclusions Lightweight should be considered in the design of ballistic helmet, and the research findings provide scientific references for the design of ballistic helmet.

The Effect of Novel Ballistic Helmet Weight on Cervical Spine Injury under Bullet Impacts / 医用生物力学

Objective To establish a valid human head-neck model and ballistic helmet model, and analyze biomechanical responses of the cervical spine under bullet impacts on ballistic helmet with different weights. Methods A uniformly distributed weight of 2 kg was applied on the helmet (1.24 kg), and bullet impacts from frontal, lateral and crown directions at the speed of 450 m/s were considered to obtain the mechanical response of human vertebrae. Results The stress of the cervical spine was significantly higher than that of the skull under bullet impacts, and the stress of C3 segment was the largest, indicating that the cervical spine was more vulnerable than the head during bullet impacts under the protection of ballistic helmet. When the weight of helmet attachment was not considered, the maximum stress of the cervical spine under lateral impact was 2.58% higher than that under frontal and crown impacts. The frontal impact led to the greatest damage to the head, with an increase of 59.4% in head stress. When the weight of helmet attachment was considered, a lager helmet weight would cause a more serious spine injure. When the helmet weight was increased from 1.24 kg to 3.24 kg, the crown impact led to the greatest damage to the cervical spine, with an increase of 12.98% in cervical stress compared with impacts from other directions. Conclusions Lightweight should be considered in the design of ballistic helmet, and the research findings provide scientific references for the design of ballistic helmet.

Clinics in diagnostic imaging (192). Flexion teardrop fracture

An 82-year-old woman presented with neck pain and bilateral upper limb paraesthesia after sustaining an unwitnessed fall at home the day before. Physical examination revealed tenderness over the C4-6 region but no evidence of step deformity or neurological deficit. Magnetic resonance imaging of the cervical spine revealed multiple small fractures at the anteroinferior endplate corners of the C3, C5 and C6 vertebrae with focal kyphosis and marrow oedema at these levels, as well as associated disruption of the anterior longitudinal ligament and central spinal canal stenosis. The diagnosis of multiple flexion teardrop fractures was made based on these imaging findings, and the patient subsequently received conservative management. This paper illustrates the radiological features of flexion teardrop fractures and highlights the importance of prompt diagnosis and management of such cases.

Outcomes of Anterior Cervical Fusion Using Polyetheretherketone Cage with Demineralized Bone Matrix and Plate for Management of Subaxial Cervical Spine Injuries / 대한신경손상학회지

OBJECTIVE: We evaluated the usefulness of a polyetheretherketone (PEEK) cage filled with demineralized bone matrix (DBM) and plate fixation in anterior interbody fusions for subaxial cervical spine injuries. METHODS: A retrospective review of 98 patients (58 women, 40 men; mean age, 49.7 years; range, 17–78 years) who underwent single-level anterior cervical discectomy and fusion (ACDF) using a PEEK cage filled with DBM and plate fixation for subaxial cervical spine injuries from March 2005 to June 2018 was conducted. Bone fusion, interbody height (IBH), segmental lordosis, and adjacent segment degeneration (ASD) development were assessed with plain radiographs and computed tomography. Clinical outcomes were assessed using a visual analog scale (VAS) for pain and the Frankel grade for neurologic function. RESULTS: The mean follow-up period was 27.6 months (range, 6–142 months). Twenty-one patients (21.4%) had an improvement of at least one Frankel grade. The mean preoperative and final follow-up neck pain VAS scores were 8.3±0.9 and 2.6±1.5 (p < 0.05). All patients showed solid fusion at the final follow-up. The mean preoperative and final Cobb's angles were −3.7±7.9° and 1.9±5.1° (p < 0.05). The mean preoperative and final IBHs were 36.9±1.7 mm and 38.2±1.8 mm (p < 0.05). Five patients (5%) showed ASD. CONCLUSION: ACDF using a PEEK cage filled with DBM and plate fixation yielded high fusion rates and satisfactory clinical outcomes without donor-site morbidity. This procedure is safe and effective for single-level subaxial cervical spine injuries.

Clinical observation of anterior cervical decompression and titanium mesh with locking plate fixation for treatment of cervical spondylosis / 中国基层医药

Objective To investigate the clinical effect of anterior cervical decompression and titanium mesh with locking plate fixation in the treatment of cervical spondylosis.Methods From January 2015 to January 2016,58 patients with cervical spondylosis in Zhoushan Hospital of Traditional Chinese Medicine were selected and randomly divided into two groups,with 29 cases in each group.The control group received the anterior cervical decompression and autogenous iliac bone graft with locking plate fixation.The observation group received anterior cervical decompression and titanium mesh with locking plate fixation.The operation time,bleeding volume and postoperative complications were recorded in the two groups.The patients were followed up for 1 year after operation,the recovery of neurological function was evaluated by,JOA standard,and the bone graft fusion rate was compared between the two groups.Results The operation time,blood loss of the observation group were (80.12 ±5.13)min,(61.45 ± 3.75) mL,respectively,which were significantly less than those of the control group,the differences were statistically significant (t =2.956,2.254,all P ＜ 0.05).The incidence rate of postoperative complications in the observation group was 6.90％,which was significantly lower than 24.14％ in the control group,the difference was statistically significant(x2 =8.540,P ＜ 0.05).The postoperative JOA score of the observation group was (88.95 ± 10.41)points,which was significantly higher than (82.11 ± 7.03)points of the control group,the difference was statistically significant (t =2.192,P ＜0.05).After 1 year follow-up,the fusion rate of the observation group was 96.55％ (28/29),which of the control group was 93.10％ (27/29),the difference was not statistically significant (x2 =2.862,P =0.090).Conclusion Anterior cervical decompression and titanium mesh with locking plate fixation in the treatment of cervical spine injury has good curative effect,and has the advantages of small trauna and high bone fusion rate.

Polyetheretherketone Cage with Demineralized Bone Matrix Can Replace Iliac Crest Autografts for Anterior Cervical Discectomy and Fusion in Subaxial Cervical Spine Injuries

OBJECTIVE: This study aimed to compare the clinical and radiologic outcomes of patients with subaxial cervical injury who underwent anterior cervical discectomy and fusion (ACDF) with autologous iliac bone graft or polyetheretherketone (PEEK) cages using demineralized bone matrix (DBM). METHODS: From January 2005 to December 2010, 70 patients who underwent one-level ACDF with plate fixation for post-traumatic subaxial cervical spinal injury in a single institution were retrospectively investigated. Autologous iliac crest grafts were used in 33 patients (Group I), whereas 37 patients underwent ACDF using a PEEK cage filled with DBM (Group II). Plain radiographs were used to assess bone fusion, interbody height (IBH), segmental angle (SA), overall cervical sagittal alignment (CSA, C2–7 angle), and development of adjacent segmental degeneration (ASD). Clinical outcome was assessed using a visual analog scale (VAS) for pain and Frankel grade. RESULTS: The mean follow-up duration for patients in Group I and Group II was 28.9 and 25.4 months, respectively. All patients from both groups achieved solid fusion during the follow-up period. The IBH and SA of the fused segment and CSA in Group II were better maintained during the follow-up period. Nine patients in Group I and two patients in Group II developed radiologic ASD. There were no statistically significant differences in the VAS score and Frankel grade between the groups. CONCLUSION: This study showed that PEEK cage filled with DBM, and plate fixation is at least as safe and effective as ACDF using autograft, with good maintenance of cervical alignment. With advantages such as no donor site morbidity and no graft-related complications, PEEK cage filled with DBM, and plate fixation provide a promising surgical option for treating traumatic subaxial cervical spine injuries.

Application of Airtraq(R) Optical Laryngoscope Combined with Bronchofibroscope for Endotracheal Intubation in Patients with Cervical Spine Injury / 中国康复理论与实践

Objective To explore the application of Airtraq(R) optical laryngoscope combined with bronchofibroscope for endotracheal in-tubation (EI) in patients with cervical spine injury (CSI). Methods 50 patients with CSI undergoing spine surgery under combined general anesthesia were randomly assigned to two groups, group A (n=25) received EI by using Airtraq(R) optical laryngoscope and group AF (n=25) received EI by using Airtraq(R) optical laryngoscope combined with bronchofibroscope. The intubation time (IT), success rate of single intuba-tion (SRSI), hemodynamic changes in endotracheal intubation, and complications related to EI were observed. Results IT was significantly longer in group A than in group AF (P0.05). Conclusion Airtraq(R) optical laryngoscope combined with bronchofibroscope would be safely and effectively used for EI in patients with CSI.

¿A qué paciente con un potencial trauma raquimedular cervical se debe estudiar con imagenología?: guía basada en la evidencia / Which patients with a potential trauma of the cervical spine and spinal cord should undergo imaging studies?: evidence-based guideline

En el manejo agudo del paciente con politrauma se afirma que cualquier individuo que haya sufrido un traumatismo por encima del nivel de las clavículas, debe considerarse que potencialmente tiene un trauma de raquis cervical (TRM). Sin embargo, es claro que menos de un 3% de los mismos tienen un riesgo seguro de tener efectivamente un TRM. En agudo, estos pacientes deben manejarse con inmovilización cervical y luego habrá que decidir a que pacientes solicitar estudios de imagen y que estudio solicitar. Dado que mas del 95% de los estudios radiológicos solicitados a pacientes con potencial TRM son normales, es lógico intentar racionalizar el uso de los mismos, pero manteniendo siempre la seguridad para el paciente. Basados en una extensa revisión bibliográfica los autores proponen un algoritmo de manejo clínico y paraclínico para los pacientes que potencialmente han sufrido un TRM...

Comparison of functional and neurological outcome of conservative and operative management in patients with cervical spine injury with complete quadriplegia.

Background: Cervical spine injury leads to significant functional impairment, one of them is quadriplegia. Debate between surgical versus conservative management of trauma to cervical spine has been going on since early 19th century. Aims & Objective: This study has been conducted to compare functional and neurological outcome of conservative and operative management in patients with cervical spine injury with complete quadriplegia. Materials and Methods: This was a retrospective study. Case records of 30 patients were analyzed. Patients were divided into 2 groups according to treatment given, i.e. Surgical and conservative. These two groups were compared retrospectively in terms of age, sex, type of injury, Mechanism of injury, mode of injury, stability, hospital stay, complications, neurological involvement and outcome. All patients were evaluated based on four parameters work, Functional independence measure, stability and neurological impairment. These parameters were measured and graded with appropriate modified scale. Results: Mean age of patients in this study was 35 Yr. (Operative 31.88 Yr, Conservative 38.2 Yr.) With approximately 73 % belongs to 20 to 40 years group of young and active individual. Road traffic accident was the major culprit for cervical spine injury in this study. It accounts for 46.66% of total patients, followed by fall from height and fall of heavy object on patient. In operative group out of 15 patient 3 had stable cervical spine injury & 12 had unstable injury. In conservative group 5 had stable cervical spine injury and 10 had unstable cervical spine injury. Overall among 30 patient only 15 patient (50%) improve neurologically other remained same or worsened. Neurological improvement in conservative (46.66%) and operative (53.33%) group was found practically to be with negligible difference. Conclusion: The ultimate neurological and functional outcome of cervical injury was probably decided at time of injury itself rather than by chosen management. Improvement in neurological function was independent of factor like type of surgery, Mechanism of injury (flexion-extension), spinal deformity and type of management. Surgical stabilization result in batter alignment and stability, early rehabilitation and probably decrease in length of stay but has its own complication and great economic burden to patients.

Clinical Analysis of Lower Cervical Spine Injury according to Injury Mechanism: Data of 277 Surgical Patients / 대한정형외과학회잡지

PURPOSE: To analyze the incidence and treatment outcomes of lower cervical spine injury since there is no long term, large Korean data available. MATERIALS AND METHODS: We analyzed 277 patients with lower cervical spine injury who underwent surgical treatments between May 1994 and October 2008. The injury types are based on Allen's classification, and neurologic injury was classified as complete, incomplete cord injury, root injury and no neurologic status. We analyzed postoperative complications, neurologic recovery and the relief of pain. RESULTS: Distractive-extension injury occurred most commonly in 140 patients (50.5%). Neurologic injury was detected in 232 cases (83.8%); 46 (16.6%) complete cord injury; 154 (55.6%) incomplete cord injury; and 32 (11.6%) root injury. Incomplete cord injury of distractive extension injury was poorly recovered. Clinical outcomes demonstrated improvement compared with the preoperative values in mean visual analogue scale. Complications were respiratory failure, neurogenic bladder, urinary tract infection and gastritis. CONCLUSION: This study showed the highest incidence of distractive extension injury and neurologic injury contrary to previous studies. This result was caused by the use of plain radiograph to establish Allen's classification in the past. Therefore, we suggest the use of magnetic resonance imaging for evaluating soft tissue injury with Allen's classification to achieve accurate assessment.

Interobserver and Intraobserver Reliability of Sub-Axial Injury Classification and Severity Scale between Radiologist, Resident and Spine Surgeon

OBJECTIVE: The sub-axial injury classification (SLIC) and severity scale was developed to decide whether to operate the cervical injured patient or not, but the reliability of SLIC and severity scale among the different physicians was not well known. Therefore, we evaluated the reliability of SLIC among a spine surgeon, a resident of neurosurgery and a neuro-radiologist. METHODS: In retrograde review in single hospital from 2002 to 2009 years, 75 cases of sub-axial spine injured patients underwent operation. Each case was blindly reviewed for the SLIC and severity scale by 3 different observers by two times with 4 weeks interval with randomly allocated. The compared axis was the injury morphology score, the disco-ligamentous complex score, the neurological status score and total SLIC score; the neurological status score was derived from the review of medical record. The kappa value was used for the statistical analysis. RESULTS: Interobserver agreement of SLIC and severity scale was substantial agreement in the score of injury morphology [intraclass correlation (ICC)=0.603] and total SLIC and severity sacle (ICC value=0.775), but was fair agreement in the disco-ligamentous complex score (ICC value=0.304). Intraobserver agreements were almost perfect agreement in whole scales with ICC of 0.974 in a spine surgeon, 0.948 in a resident of neurosurgery, and 0.963 in a neuro-radiologist. CONCLUSION: The SLIC and severity scale is comprehensive and easily applicable tool in spine injured patient. Moreover, it is very useful tool to communicate among spine surgeons, residents of neurosurgery and neuro-radiologists with sufficient reproducibility.

Accuracy and Safety in Pedicle Screw Placement in the Thoracic and Lumbar Spines : Comparison Study between Conventional C-Arm Fluoroscopy and Navigation Coupled with O-Arm(R) Guided Methods

OBJECTIVE: The authors performed a retrospective study to assess the accuracy and clinical benefits of a navigation coupled with O-arm(R) system guided method in the thoracic and lumbar spines by comparing with a C-arm fluoroscopy-guided method. METHODS: Under the navigation guidance, 106 pedicle screws inserted from T7 to S1 in 24 patients, and using the fluoroscopy guidance, 204 pedicle screws from T5 to S1 in 45 patients. The position of screws within the pedicle was classified into four groups, from grade 0 (no violation cortex) to 3 (more than 4 mm violation). The location of violated pedicle cortex was also assessed. Intra-operative parameters including time required for preparation of screwing procedure, times for screwing and the number of X-ray shot were assessed in each group. RESULTS: Grade 0 was observed in 186 (91.2%) screws of the fluoroscopy-guided group, and 99 (93.4%) of the navigation-guided group. Mean time required for inserting a screw was 3.8 minutes in the fluoroscopy-guided group, and 4.5 minutes in the navigation-guided group. Mean time required for preparation of screw placement was 4 minutes in the fluoroscopy-guided group, and 19 minutes in the navigation-guided group. The fluoroscopy-guided group required mean 8.9 times of X-ray shot for each screw placement. CONCLUSION: The screw placement under the navigation-guidance coupled with O-arm(R) system appears to be more accurate and safer than that under the fluoroscopy guidance, although the preparation and screwing time for the navigation-guided surgery is longer than that for the fluoroscopy-guided surgery.

The Relationship between Spinal Stenosis and Neurological Outcome in Traumatic Cervical Spine Injury: An Analysis using Pavlov's Ratio, Spinal Cord Area, and Spinal Canal Area

BACKGROUND: This study examined the relationship between four radiological parameters (Pavlov's ratio, sagittal diameter, spinal cord area, and spinal canal area) in patients with a traumatic cervical spine injury, as well as the correlation between these parameters and the neurological outcome. METHODS: A total of 212 cervical spinal levels in 53 patients with a distractive-extension injury were examined. The following four parameters were measured: Pavlov's ratio on the plain lateral radiographs, the sagittal diameter, the spinal cord area, and the spinal canal area on the MRI scans. The Pearson correlation coefficients between the parameters at each level and between the levels of each parameter were evaluated. The correlation between the radiological parameters and the spinal cord injury status classified into four categories, A (complete), B (incomplete), C (radiculopathy), and D (normal) was assessed. RESULTS: The mean Pavlov's ratio, sagittal diameter, spinal cord area and spinal canal area was 0.84, 12.9 mm, 82.8 mm2 and 236.8 mm2, respectively. An examination of the correlation between the radiological spinal stenosis and clinical spinal cord injury revealed an increase in the values of the four radiological parameters from cohorts A to D. Pavlov's ratio was the only parameter showing statistically significant correlation with the clinical status (p = 0.006). CONCLUSIONS: There was a correlation between the underlying spinal stenosis and the development of neurological impairment after a traumatic cervical spine injury. In addition, it is believed that Pavlov's ratio can be used to help determine and predict the neurological outcome.

Anterior Fusion with Caspar Plating in Traumatic Cervical Spine Instability

OBJECTIVE: In these retrospective studies, the authors report an evaluation of clinical and radiological outcome in patients with cervical spine injury who underwent anterior cervical fusion with Caspar Plating system. METHODS: The authors studied 45 patients with unstable cervical spine after trauma between July 1996 and December 2001. Our series consist of 39 male and 6 female. The cervical spine injury was most common in men in fourth decade. Motor vehicle accidents were a frequent cause of cervical spine injury. Thirty-three patients had fractures with instablity, ten a ligamental injury without fracture, one traumatic hernated disc. Lateral cervical spine X-rays were reviewed for evaluation of fusion and instrumentation failure. RESULTS: In most cases, operation for stabilization was done around one weeks after trauma. In all patients excellent immediate postoperative stability of the spine was obtained, although posterior fusion was necessary at same time in one patient. Solid fusion was achieved in all except two patients who died during the first 2 months after the operation. Three patients developed instrumentation related failure(6.7%): Two patients had screw loosening, one infection. Two of these patients underwent reoperation. The most dreaded complication of dural or cord penetration by drilling or screw placement was not observed. There was no postoperative neurological disturbances. Four patients died of causes unrelated to operation: Two patients died of upper gasterointestinal bleeding, and the other two died of pneumonia and sepsis respectively. CONCLUSION: The Caspar plating system affords an effective means of improving the fusion rate with acceptable instrumentaton-related morbidity in cervical spine injury.

Treatment of Cervical Cord Injury in Ankylosing Spondylitis

Cervical cord injury in patient with ankylosing spondylitis frequently occurs despite of minor trauma, such as slip down injury in drunken state or minor motor-vehicle accident. The level of cord injury is usually at lower cervical and upper thoracic area. The treatments and combined complications in ankylosing spondylitis patients are quite different from other spinal cord injuries. We report four cases of cervical cord injuries in patients with ankylosing spondylitis. Two among 4 patients expired due to sepsis caused by chest problem, and the others recovered after surgery.

Analysis of Posterior Cervical Fixation and Fusion in Subaxial Cervical Spine Injury

OBJECTIVE: In the retrospective analyzing 19 consecutive patients with subaxial cervical spine(C3~T1) injury treated by posterior cervical fixation and fusion, clinical manifestation, radiologic finding, operative technique, and postoperative results following 6 months were analyzed. MATERIALS AND METHODS: Most common fracture level was C4-5, mean age 41, and male to female ratio 13: 6. The most common cause of injury was motor vehicle accident(17 cases). In 19 cervical procedures, interspinous triple wiring was done in 14 cases, lateral mass plating in 5 cases, and additional anterior fusion in 2 cases. RESULTS: Twelve weeks after operation, all cases were reviewed by plain cervical radiogram. In 17 cases that treated by posterior fusion only, 14 cases(81%) had kyphotic angle change less than 5degrees, 2 cases(12%) 5-20degrees, and 1 case(6%) more than 20degrees. Overall fusion rate was 88%, and there was no significant difference of bone fusion rate between autogenous bone graft and allogenous bone graft. CONCLUSION: In the case of severe posterior column injury or displacement, posterior approach seems superior to anterior approach, but in the case of combined anterior column injury, anterior approach is considered necessary. In this study, posterior fixation and fusion might be acceptable procedure for subaxial cervical fracture and dislocation, owing to its high fusion rate, low kyphotic angulation and low operation related complication rate.