Treatment strategies for lower cervical distractive flexion injuries / 中华创伤杂志

ABSTRACT

Objective To discuss the strategies for treatment of lower cervical distractive flexion injuries. Methods Sixty-eight patients including 43 males and 25 females at age range of 18-72 years (average 43 years) suffered from lower cervical distractive flexion injuries were operated from January 2002 to June 2007. According to Allen's classification, there were 7 patients at grade Ⅰ, 19 at grade Ⅱ,29 at grade Ⅲ and 13 at grade Ⅳ. Temporary skull traction was used for each subject before surgery. Only posterior approach was performed in 26 patients who were fixated by pedicle screw system,lateral mass screw system or transarticular screw system. Combined anterior and posterior approach was applied for the other 42 patients at one stage. The curative effect was followed up for all patients after the procedures. Results All patients were followed up for 6-65 months ( average 34 months), which showed posterior incision infection in 2 patients who were cured after debridement or change dressing. Two patients with aggravated neural symptome were cured following treatment with methylprednisolone. Neural function was improved at least for one level in all patients except for 18 patients (Frankel A). Of 11 patients at grade B, there were 4 patients improved to grade C and 5 to grade D. Of 10 patients at grade C, there were 6 patients recovered to grade D and 4 to grade E. All 15 patients at grade D reached grade E. It was not found loosening, breakage or defuxion. The graft bone was fused within 3-4 months, with no any complications related to surgical fixation. Conclusions The strategies for lower cervical distractive flexion injuries should be taken according to Allen' s classification. Single posterior procedure is suitable for grade Ⅰ and Ⅱ injuries. While combined posterior and anterior procedure can be used for grade Ⅲ and Ⅳ injuries.