Availability of Anterior Cervical Plating in Distractive Flexion Injury in Lower Cervical Spine: Radiologic Aspects / 대한척추외과학회지

STUDY DESIGN: A retrospective clinical and radiological analysis. OBJECTIVES: To evaluate the availability of anterior cervical plating in the treatment of distractive-flexion injuries of the lower cervical spine. SUMMARY OF LITERATURE REVIEW: Surgical approaches for distractive-flexion injuries of the lower cervical spine have included the anterior approach, the posterior approach, and the combined anterior and posterior approach. However, which approach is the most useful remains a controversial issue. MATERIALS AND METHODS: We reviewed the outcomes of 30 patients, who were followed-up for an average of 16 months (range, 12-43 months) after undergoing fusions with anterior cervical plating for distractive-flexion injuries of the lower cervical spine from July 1995 to July 2004. The average age of these patients was 52.9 years (range 24-77 years) and male-to-female ratio was 26:4. Group A consisted of 19 cases that were composed of unilateral dislocations and Group B consisted of 11 cases that were composed of bilateral dislocations based on Allen s classification. Group A1 (9 cases) and B1 (8 cases) were composed of cases that had fractures on the superior end plates or facet joints of the lower cervical spine in each group. Group A2 (10 cases) and B2 (3 cases) were composed of cases without fractures in each group. Neurologic symptoms were evaluated by the Frankel classification; and the angle of lordosis, disc height, and duration of bony union were analyzed postoperatively and with the last follow-up roentgenograms. RESULTS: Clinically, 22 (73%) patients had neurologic deficits, which were composed of 9 (41%) cases of complete injury, 7 (32%) cases of incomplete injury, and 6 (27%) cases of nerve root injury. The nerve root injuries recovered in all cases and the incomplete injuries had an average 1.7 grade recovery by the Frankel classification. Radiologically, the loss of lordosis was 2.2+/-1.7degrees in group A, 3.1+/-2.8degrees in group B (p=0.359), 3.0+/-1.6degrees in group A1, 1.5+/-1.5degrees in group A2 p=0.048), 3.5+/-3.1degrees in group B1, and 2.1+/-1.7degrees in group B2. Loss of disc height was 1.7+/-1.1 mm in group A, 2.2+/-0.9 mm in group B( p=0.201), 2.2+/-0.9 mm in group A1, 1.2+/-1.0 mm in group A2 (p=0.046), 2.5+/-0.6 mm in group B1, and 1.2+/-1.1 mm in group B2. The duration for bony union was 12.9+/-2.8 weeks in group A, 14.1+/-2.7 weeks in group B (p=0.044), 13.9+/-2.1 weeks in group A1, 11.9+/-3.0 weeks in group A2 (p=0.046), 14.4+/-2.9 weeks in group B1, and 13.3+/-2.3 weeks in group B2. There was no graft displacement, nonunion or metal failure. CONCLUSION: Anterior cervical plating was an effective treatment modality for distractive-flexion injuries of the lower cervical spine. and more firm method was necessary to surgical treatment in case of fractures on superior end plate or facet joint.

Fracture of the Cartilagenous End Plate of the Lower Lumbar Vertebral body: 3 Case Report / 대한정형외과학회잡지

Fracture of the vertebral end plate in the lumbar spine has been reported as a rare lesion occurring in the adolescent period. It is characterized by variable degrees of sign and symtom related to the degree of block on myelogram and the level of end plate fracture. Trauma or strenuous sport activity seems to play an improtant role in the production of fracture of vertebral body in the adolescent period. We experienced three cases of fracture of lower lumbar vertebral end plate in teenaged patients, two males and one female. Two patients showed upper end plate fracture with severe neurologic deficit on the involved root level and a strong positive on straight leg raising test, and one patient showed lower end plate fracture with slight neurologic deficit. Two patients with upper end plate fracture were treated with partial laminectomy with removal of fracture fragment and one patient with lower end plate fracture was treated with bilateral laminectomy and posterolateral fusion. The method of treatment will depend upon the type of fracture and the degree of neurologic symptoms. We obtained satisfactory results with posterior decompressive laminectomy and removal of fracture fragment with or without fusion.