J Korean Orthop Assoc.  2012 Feb;47(1):15-20. 10.4055/jkoa.2012.47.1.15.

The Relationship between Soft Tissue Damages and Neurologic Deficits in Distractive Extension Injury of the Lower Cervical Spine

• Song KJ
• Choi BW
• Lee KB
• Chang H

• KMID: 1439987
• DOI: http://doi.org/10.4055/jkoa.2012.47.1.15

Abstract

PURPOSE
To evaluate the relationship between the damage to anterior soft tissues and neurological deficit in distractive extension injury of the lower cervical spine.
MATERIALS AND METHODS
Ninety-two patients who were treated surgically for distractive extension injury of the lower cervical spine were included in this study. Soft tissue swelling was evaluated on plain radiographs. Damage to the longus colli muscle, anterior longitudinal ligament, superior end plate, inferior end plate, annulus fibrosus, and posterior longitudinal ligament were intraoperatively checked and the relationship between these findings and clinical neurologic deficits was analyzed.
RESULTS
Soft tissue swelling was increased to 92% in the retropharyngeal space and to 89% in the retrotracheal space but there was no significant difference. No relationship was found between the damage to the prevertebral fascia, longus colli muscle and neurological deficit. Injuries to the inferior end plate and annulus fibrosus showed a directly propotional relation with neurological deficit, but it was not significant. Injuries to the anterior longitudinal ligament (p<0.01), superior end plate (p=0.02), posterior longitudinal ligament (p=0.04) showed significant relations with neurological deficit.
CONCLUSION
The distractive extension injury combined with the damage to the anterior longitudinal ligament, superior end plate or posterior longitudinal ligament showed high frequency of neurological deficit. Hence, these are regarded as the important structures for maintaining the stability of the lower cervical spine.

Keyword

lower cervical spine; distractive extension injury; neurologic deficits; soft tissue damage

MeSH Terms

Fascia
Humans
Longitudinal Ligaments
Muscles
Neurologic Manifestations
Spine

Figure

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  Figure 1 The evaluated soft tissue structures in the surgical field. A, prevertebral fascia; B, longus colli muscle; C, anterior longitudinal ligament; D, superior end plate; E, inferior end plate; F, posterior annulus fibrosus; G, posterior longitudinal ligament.

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