J Korean Soc Spine Surg.  2007 Dec;14(4):221-228.

Treatment of Distractive Flexion Injury in Lower Cervical Spine using Anterior Cervical Fusion

• Park HJ
• Shim YJ

Abstract

STUDY DESIGN: A retrospective study.
OBJECTIVES
To evaluate the availability of anterior cervical plating in the treatment of distractive flexion injury of the lower cervical spine and the relationship between the neurologic findings, types of dislocation, and disc herniation. SUMMARY OF LITERATURE REVIEW: Anterior stabilization of unstable cervical spine injuries is increasing. However, the stability of anterior stabilization only is controversial for the treatment of bilateral dislocation of the cervical spine. MATERIAL AND METHODS: We retrospectively analyzed 32 patients treated with anterior decompression, auto-iliac bone graft, and anterior cervical plating, who suffered from distractive flexion injury in the lower cervical spine from Feb. 1999 to Feb. 2006. Unilateral dislocation occurred in 21 cases, bilateral dislocation in 11 cases, with evaluation of disc status at the injured level conducted after closed reduction by MRI. We statistically analyzed changes in vertebral body height, disc angle, fusion rate, neurologic recovery, and complications.
RESULTS
All cases were fused by 12.3+/-2.7 weeks after operation, and the loss of anterior and posterior vertebral body height were statistically significant (p=0.00, 0.00), changes in the disc angle were not (p=0.53). Herniation of the disc was more frequent in unilateral dislocation (p=0.02). Clinically 21 (65%) patients had neurologic deficits, but nerve root injuries recovered in all cases, with the original average ASIA motor score of 55.2 improving to 68.3 at last follow up.
CONCLUSIONS
Anterior decompression, bone grafting, and metallic osteosynthesis were effective treatment modalities for distractive-flexion injuries of the lower cervical spine, causing slight vertebral body height decreases but no loss of reduction or neurologic compromise.

Keyword

Cervical spine; Distractive flexion injury; Anterior plating

MeSH Terms

Asia
Body Height
Bone Transplantation
Decompression
Dislocations
Follow-Up Studies
Humans
Magnetic Resonance Imaging
Neurologic Manifestations
Retrospective Studies
Spine*
Transplants

Figure

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  Fig. 1. Radiograph showing linear and angular measurement.

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  Fig. 2. A 47 year old male patient with C5 nerve root injury due to bilateral facet dislocation. (A) Preoperative lateral roentgenogram shows 50% anterior displacement of C4 on C5 body. (B) T2 weighted sagittal MR image shows a C4-5 disc protrusion. (C) Lateral radiograph, immediately after surgery, shows anterior cervical fusion with autogenous iliac bone and cervical spine locking plate. (D) Lateral radiograph, 12months after surgery, shows the consolidation of grafted bone.

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  Fig. 3. A 59year old male patient with central cord syndrome due to unilateral facet dislocation. (A)Preoperative lateral roentgenogram shows 30% anterior displacement of C5 on C6 body. (B)T2 weighted sagittal MR image shows a C5-6 disc rupture and diffuse hyperintensity cord lesion at C5-C6 level. (C) Lateral radiograph, immediately after surgery, shows anterior cervical fusion with autogenous iliac bone and cervical spine locking plate. (D) Lateral radiograph, 24months after surgery, shows the consolidation of grafted bone.

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