Availability of Anterior Cervical Plating According to the Severity of Injury in Distractive Flexion Injury in Lower Cervical Spine / 대한정형외과학회잡지

ABSTRACT

PURPOSE: To evaluate the availability of anterior cervical plating in the treatment of distractive-flexion injury in lower cervical spine comparing the result of circumferential fusion with the one of anterior cervical plating alone and fusion. MATERIALS AND METHODS: We retrospectively analysed 50 consecutive patients treated with surgically, who suffered from distractive flexion injury in lower cervical spine. Group A, 28 cases were composed of unilateral dislocation (Allen stage I or II) and anterior plating and fusion. Group B, 10 cases were composed of bilateral dislocation (Allen stage III) and anterior plating and fusion. Group C, 5 cases were composed of unilateral dislocation and circumferential fusion. Group D, 7 cases were composed of bilateral dislocation (Allen stage III or IV) and circumferential fusion. We statistically analysed the results such as the change of vertebral height and Cobb' angle, fusion time, neurologic recovery, fusion rate, operation time, and complications. RESULTS: The mean fusion time of each groups were 3.75+/-2.10 months in A, 6.00+/-2.82 months in B, 3.60 +/-1.34 months in C, 3.85+/-2.26 months in D and a significant difference shows between group B and A, D (Mann-Whitney U test, p=0, 012, p=0.014). In operation time, a significant difference shows between A, B and C, D. No significant difference shows the changes of vertebral height and Cobb's angle, fusion rate, neurologic recovery. In complications, distal screw loosening was 2 in A, 1 in B and delayed union was 2 in A, 1 in B. No complication was in C and D. CONCLUSION: Combined anterior posterior fixation and fusion was superior to anterior fusion alone in respect of stability and fusion rate, but it caused the increase of morbidity by long operation time. Anterior plating and fusion in bilateral dislocation shows the increase of fusion time, but there were no difference in the clinical outcome such as neurologic recovery and complications. So Anterior fusion alone could be recommended as an alternative surgical method for the treatment of bilateral facet dislocation in the lower cervical injury.