Clinical Analysis of Anterior Fixation with Caspar Plate in Unstable Cervial Spine

The authors analyzed 19 cases of unstable cervical spine injuries who had been treated by anterolateral approach with Caspar plate at the department of neurosurgery of Hangang Sacred Heart hospital during 3 years from 1989. The results were as follows: 1) The unstable cervical spine injury was most common in 3rd decade of age. Male to female ratio was 3.75:1. 2) Regarding the level of injury, C5-6 injury was most common. 3) The most common cause of injury was fall down from height(47.4%) and the next was traffic accident(36.8). 4) In all cases received anterior reconstructive surgery using Caspar plate showed significant neurologic improvement. 5) In all cases received anterior reconstructive surgery showed a good restoration of cervical spinal stability. 6) The major surgical complication was esophageal fistula and all complications were treated without any sequelae. 7) Anterior reconstructive surgery using Caspar plate is considered one of the surgical options in patient of cervical spine injury with severe instability.

Internal Fixation of the Unstable Cervical Spine Fracture and Subluxation

Recently various kinds of anterior or posterior cervical instruments have been used for stabilization of unstable cervical spinal injury. Every device has different characteristics, so none can cover all of the various types of unstable injuries. Forty six patients of unstable cervical spine fracture and subluxation underwent stabilizing operation using the anterior Caspar plate(6 cases) and the Roy-Camille posterior plate system(40 cases) during recent 3-years. Each approach employed depends on the site of compression and mechanism of injury. Six patients who had complete neurological injury expired after the surgery. The follow-up period for the 40 patients was from 5 to 32 months(average-17.5 months). During follow-up period, 16 out of 22 patients(72.7%) who had a neurological deficit showed minimal to moderate improvement and only 4 patients(10%) complained of significant arm or neck pain. The only complication of instrumentation was 5 cases of screw breakout, but 3 of them did not have any problem. Radiologically 37 patients(92.5%) had firm fixation after surgery.

Posterior Cervical Plate Fixation in Cervical Injuries

Posterior stabilization of unstable cervical spine injury using metal plate and screw has been commonly used in Europe but very rarely in Korea where it has been usually achieved with wires supplemented by bone graft. We have experienced 11 patients of unstable lower cervical spine injuries which were stabilized with posterior cervical plate without bone graft. One patient was total quadriplegia and two patients showed minor motor and sensory changes and the others were neurologically intact. Operations were performed within 10 days after trauma(average 4.9 days) except 2 cases of late instability. Most of the patients could ambulate the day after operation with a Philadelphia collar which was kept for 3 months. We achieved good postoperative alignment of injured cervical spine and tolerable neck motion limitation and we experienced no surgical complication. So we suggest that posterior cervical plate fixation technique is a good method of cervical stabilization for lower cervical spine injury, especially when posterior compartment injury is predominant.