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.

Direct Reduction and Fixation for Unstable Hangman's Fracture with Posterior Lateral Mass Plating: Report of 4 Cases

While most patients with hangman's fracture could be effectively managed with non-operative treatment, surgical intervention should be considered in unstable hangman's fracture with severe C2-3 dislocation or angulation. Author modified the posterior lateral mass plating techinic for the unstable hangman's fracture. While the C3 screw fixation was done with usual manner, author applied the long lag screw instead of usual short- or medium-sized screw through the isthmus of C2 for direct reduction and fixation of fractured segment. It is similar to anterior screw fixation for odontoid type II fracture in terms of simutaeneous reduction and fixation. Besides these procedure interfacetal fusion and ligamentoplasty were added in C2-3 articulation. Surgical point of view was discussed with literature review.