Anterior cervical fixation in type-II traumatic spondylolisthesis of the axis: a report of eighteen cases, and discussing the rationale of management

Eighteen adult consecutive patients with type-II traumatic spondylolisthesis of the axis were included retrospectively in this study. The average age was 32.5 years. Fourteen were males and 4 were females. The cause of injury in all patients was road traffic accident but in 2 patients was a fall. Preoperatively, all patients were neurologically intact except two; one was tetra paretic and the other one was atypical brown Sequard's syndrome. Associated head trauma was reported in 5 patients and other cervical fractures in 5 patients. All patients were treated primarily with anterior C2/C3 auto graft and plating after closed reduction. Reduction was complete and healing was uneventful in all patients. there plating after closed reduction. There were no reported morbidity or mortality. Hospital stay was 8 days in 15 patients including the time of closed reduction. Both paretic patients recovered with minimal gait difficulty. Proper typing and grading of hangman's fractures is mandatory for a better management. Early surgical fusion is recommended for hangman's fractures of the effendi-type II and III. Anterior plating is a simple effective choice for hangman's fractures. It shortens hospital stay and skeletal tractions time

Outcome of thoracolumbar burst fractures: decompression, pedicle screw fixation and posterolateral fusion

A total of 29 patients with unstable [according to Denis classification] thoracolumbar burst injury underwent transpedicular spinal instrumentation using the SAS screw-rod system. We were able to follow-up 23 patients for more than 6 months. The 23 patients [13 males and 10 females] with mean age 33.30 +/- 10.18 years [range 19-56 years] presented with severe back pain. Four patients with complete neural injury 14 patients with partial neural injury, and 5 without neurological deficit Surgery consisted of either indirect or direct neural decompression, internal fixation, and autogenous iliac bone grafting. Annulotaxis was performed in patients with complete injury [n=4] and those with canal compromise more than <40% [n=10]. Transpedicular decompression was performed for other patients. A total of 92 pedicle screws were placed in 20 patients with one unstable motion segment and 3 patients with two unstable motion segments. All patients were submitted for routine clinical and radiographic follow-up including CT-scan. Mechanical stability was maintained through the follow-up in all patients with fusion rate of 87%. All screw purchases were satisfactory but 5 [94.57%]. Mean kyphus deformity reduced from 20.09 +/- 9.77 to 11.26 +/- . 6.25 degrees postoperative. Mean canal compromise corrected from 36.30 +/- 23.44% to 11.74 +/- 5.56% postoperative. No operative mortality, wound infection, or necessity for reoperation were reported. All patients with partial neural injury improved at least one Frankel grade. Those with complete neural injury as well as those without neurological deficit remain unchanged. Morbidity included two isolated nerve root deficits one transient and one permanent. Pedicle screw-rod fixation allows early mobilisation, short segment fixation. and preservation of adjacent motion segments. It offers high biomechanical stability with high fusion rate. The technique is dem and ing and meticulous nevertheless it is associated with minimum morbidity in trained h and s