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

Kyung-Jin Song; Byung-Wan Choi; Kwang-Bok Lee; Han Chang

doi:10.4055/jkoa.2012.47.1.15

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Song, Choi, Lee, and Chang: The Relationship between Soft Tissue Damages and Neurologic Deficits in Distractive Extension Injury of the Lower Cervical Spine

Original Article

Journal of the Korean Orthopaedic Association

Journal of the Korean Orthopaedic Association 2012; 47(1): 15-20.

Published online: 29 February 2012

DOI: https://doi.org/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

Kyung-Jin Song, M.D., Byung-Wan Choi, M.D.^*, Kwang-Bok Lee, M.D., Han Chang, M.D.^*

Department of Orthopedic Surgery, College of Medicine, Research Institute of Clinical Medicine, Chonbuk National University, Jeonju, Korea.

^*Department of Orthopedic Surgery, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea.

Correspondence to: Byung-Wan Choi, M.D. Department of Orthopedic Surgery, Inje University Haeundae Paik Hospital, 1435, Jwa-dong, Haeundae-gu, Busan 612-030, Korea. TEL: +82-51-797-0240, FAX: +82-51-797-0249, alla1013@naver.com

Received 28 April 2011 Revised 28 June 2011 Accepted 15 July 2011

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: lower cervical spine, distractive extension injury, neurologic deficits, soft tissue damage

Figures and Tables

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.

Table 1

Causes of Injury in the Patients

Table 2

Neurological Impairment according to the Severity of Injury

^*Stage of distractive extension injury according to Allen's classification.

Table 3

The Correlation between the Soft Tissue Swelling on Plain Radiographs and Neurological Impairment

^*Number of cases in which the soft tissue swelling at the 3rd cervical vertebra was greater than 5 mm; ^†Number of cases in which the soft tissue swelling at the 6th cervical vertebra was greater than 15 mm.

Table 4

The Correlation between the Soft Tissue Damage and Neurological Impairment

^*Prevertebral fascia; ^†Longus colli muscle; ^‡Anterior longitudinal ligament; ^§Superior end plate; ^∥Inferior end plate; ^¶Posterior annulus fibrosus; ^**Posterior longitudinal ligament.

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