Unstable lower cervical spine injuries results of posterior lateral mass plate fixation

ABSTRACT

Thirty patients with unstable lower cervical spine injuries were treated from January 1998 to December 2001 using posterior lateral mass plating and autogenous iliac hone graft. There were 25 males and 5 females, the average patient age was 37.73 years [range 18-60 years]. The average duration of follow-up was 15.18 months [range 6 to 43 months]. The cause of trauma was motor vehicle accidents in 18 patients, a fall from height in 9 patients and diving into a shallow water in 3 cases. Eight patients had associated injuries, three of them suffered head injuries, 2 cases had pelvic fractures. 2 cases had femoral shaft fractures and one patient had forearm fracture. Thirty patients met the criteria for posterior cervical plating and fusion having cervical instability. Eleven patients had unilateral facet dislocation at one level, four patients had bilateral facet dislocation at one level, 13 patients had fracture dislocations either at one or two levels, and Two patients had burst fracture at one Level. Neurologically, 10 patients were neurologically free complaining of neck pain only, 8 patients had a one level root injury, 4 patients had anterior cord syndrome. 3 patients had Brown Sequard syndrome, and 5 patients had complete cord injury. The final functional results were assessed using Bohlman and Anderson criteria. No patient's neurological function deteriorated after surgery. All the patients with radicular symptoms relieved and all incomplete spinal cord injuries improved at least one ASIA Level. All the patients had solid fusion and good alignment based on flexion and extension radiographs at follow-up. Although one patient had implant failure in the form of backing out of the screws, non had an increased deformity and all progressed to sound fusion. Extension of the fusion mass beyond the instrumented levels was evident in 12 patients. There were no neurologic or vascular complications related to screws fixation. Posterior Cervical plating with lateral mass fixation and bone grafting offers a reliable method of achieving fusion, with minimal bracing and more rapid functional recovery in the treatment of fractures and dislocations of the lower cervical spine