Old injuries of the lower cervical spine treated surgically.

The present study involves 16 surgically treated patients who had sustained an old injury of their lower cervical spine. This group represents the 29% of the 55 patients that were admitted in our Department with an old injury of the cervical spine. The aim of the present study is to see the effect of surgery on these old injuries in relation to clinical and radiological parameters. Operative treatment was indicated in the presence of instability and the resulting deformity or pain or, more important, in case of further deterioration (or development) of the neurological status. The patients were followed up for 1-14.4 years (mean 5.5 years). At follow-up, fusion was sound in all but 1 patient and the deformity was improved in 12 cases. As for the clinical evaluation, pain was still present in two patients and the neurological status was improved in all but one patient with complete tetraplegia. Surgical treatment is of value irrespective of time delay to avoid fixed deformities and/or permanent neurological lesions.

The anterior inferior angle fracture of a lower cervical vertebra.

Thirty-eight cases of a "tear drop" fracture of the lower cervical spine treated in our department during the last 20 years are reported. They represent 8.3% of all cervical injuries. We classified our cases into four types with regard to the extent of the bony lesion and the resulting posterior displacement of the vertebral body. Posterior displacement is of paramount importance. Neurological lesions were present in 52.6% of the patients, and they were related to the type of injury. Five patients died, and 33 were followed up for a mean period of 10 years. Five patients were operated on. All patients with a complete neurological lesion remained unchanged irrespective of the type of treatment. Incomplete neurological lesions showed a better tendency to recover after surgical treatment. Types III and IV are the more serious lesions, and they represent an absolute indication for surgical treatment. Type I is more benign and, if treated properly, has a good prognosis similar to type II.

Fractures of the dens and risk of pseudarthrosis.

This study deals with 49 fractures of the dens treated at the Orthopedic Department of Athens University during the past 17 years. These fractures represent 14.2% of all cervical fractures treated during the same period at our department. Forty-one cases have been reviewed and analyzed, the average follow-up time being 10 years (1-16). Pseudarthrosis was found to be present in seven cases (17%), and its relationship to different factors was examined. The type of fracture and particularly the direction of the fracture line were found to be major factors leading to pseudarthrosis. Many other factors, such as displacement, traction, the stability obtained, the presence of associated injuries, and the time elapsed till treatment was started, as well as the age of the patients, seem to play--alone or in combination--important roles in the development of pseudarthrosis. These factors have been classified according to their importance and graded. With a total of 10 points or more a dens fracture is characterized as a fracture "at risk of pseudarthrosis", i.e., a fracture with a higher possibility of developing a pseudarthrosis. This knowledge may contribute to proper and earlier management of such an injury.