Surgical Experience of Cervical Spine Injury

ABSTRACT

Development of new surgical devices and approaches for management of injuries to the cervical spine has offered various methods of treatment available. Making it is not easy in choosing the most suitable method of treatment. We present our experience and results of 90 operations performed during the past eight-year-period(1986-1993) including 10 halo-vest applications. The timing of operation was within 7 days posttrauma in 34.2%, 8-14 days in 27.4%, 15-28 days in 1.0%, and over 28 days in 27.4%. In 18 cases of upper(C1-3) cervical spine injuries, 23 operations were performed, all approached from the posterior. In 5 cases of lower(C4-7) cervical spine injuries, 67 operations were performed, the anterior approach used in 33 patients and the posterior approach in 18 patients. Halo-vest was applied in 6 patients with upper cervical spine injuries and in 4 patients with lower cervical spine injuries. The halo-vest was inadequate in maintaining the stability of the injured spine in 5 out of 0 cases. The complication rate was 23.3% in postrior approaches and 32.4% in anterior approaches. Overall, 27 complications(0%) occurred in 90 operations, and the reoperation rate was 16.4%(85 operations for 73 patients, except for the halo-vest applications). Internal fixation with a variety of devices has become a popular procedure for ervical spine injuries. Despite the popular and wide usage of such devices, the occurrence of complications and the need to reoperate has rendered the procedure to be applied with much caution regarding its technical aspects and possible problems it may pose. In our study, the rate of reoperation and complications following such procedures were quite high. We conclude that in choosing the most proper surgical approach for ervical spine injuries with minimal occurrence of any complications, a stringent criteria should be adhered to rather then easily select the more fashionable, new of fancy devices over the traditional techniques.