Clinical Analysis of Lower Cervical Spine Injury according to Injury Mechanism: Data of 277 Surgical Patients

Kyung-Jin Song; Young-Jae Moon; Kwang-Bok Lee

doi:10.4055/jkoa.2012.47.4.264

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Song, Moon, and Lee: Clinical Analysis of Lower Cervical Spine Injury according to Injury Mechanism: Data of 277 Surgical Patients

Original Article

Journal of the Korean Orthopaedic Association

Journal of the Korean Orthopaedic Association 2012; 47(4): 264-270.

Published online: 27 August 2012

DOI: https://doi.org/10.4055/jkoa.2012.47.4.264

Clinical Analysis of Lower Cervical Spine Injury according to Injury Mechanism: Data of 277 Surgical Patients

Kyung-Jin Song, M.D., Young-Jae Moon, M.D., Kwang-Bok Lee, M.D.

Department of Orthopedic Surgery, Chonbuk National University Hospital, Chonbuk National University Medical School, Research Institute of Clinical Medicine, Biomedical Science Institute, Jeonju, Korea.

Correspondence to: Kwang-Bok Lee, M.D. Department of Orthopedic Surgery, Chonbuk University Hospital, 20, Geonji-ro, Deokjin-gu, Jeonju 561-712, Korea. TEL: +82-63-250-2586, FAX: +82-63-271-6538, osdr2815@naver.com

Received 10 November 2011 Revised 9 January 2012 Accepted 30 January 2012

(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 analyze the incidence and treatment outcomes of lower cervical spine injury since there is no long term, large Korean data available.

Materials and Methods

We analyzed 277 patients with lower cervical spine injury who underwent surgical treatments between May 1994 and October 2008. The injury types are based on Allen's classification, and neurologic injury was classified as complete, incomplete cord injury, root injury and no neurologic status. We analyzed postoperative complications, neurologic recovery and the relief of pain.

Results

Distractive-extension injury occurred most commonly in 140 patients (50.5%). Neurologic injury was detected in 232 cases (83.8%); 46 (16.6%) complete cord injury; 154 (55.6%) incomplete cord injury; and 32 (11.6%) root injury. Incomplete cord injury of distractive extension injury was poorly recovered. Clinical outcomes demonstrated improvement compared with the preoperative values in mean visual analogue scale. Complications were respiratory failure, neurogenic bladder, urinary tract infection and gastritis.

Conclusion

This study showed the highest incidence of distractive extension injury and neurologic injury contrary to previous studies. This result was caused by the use of plain radiograph to establish Allen's classification in the past. Therefore, we suggest the use of magnetic resonance imaging for evaluating soft tissue injury with Allen's classification to achieve accurate assessment.

Keywords: Allen classification, Korean data, lower cervical spine injury

Figures and Tables

Figure 1

(A) Preoperative C-spine lateral radiograph shows no bony abnormality except bony ossicles on C4-5, C5-6, and C6-7 disc space. (B-D) However, T2-weighted, T-1 weighted sagittal and axial magnetic resonance images show cord signal change on C3-7 and high signal intensity on the prevertebral space and posterior neck muscle group, disc extrusions and anterior longitudinal ligament disruption.

Figure 2

Final follow-up C-spine AP (A) and lateral (B) radiographs show the bony fusion on corpectomy, autogenous iliac graft and anterior plate fixation C3-7.

Table 1

Demographic Data

Table 2

Neurological Injury according to Injury Type

Values are presented as number or number (%). CCI, complete cord injury; CCS, central cord syndrome; BSS, Brown-Sequard syndrome; ACS, anterior cord syndrome; Root, root injury.

Table 3

Surgical Treatment

Table 4

Final Neurologic Status according to Injury Type (Frankel Grade)

Values are presented as number (%).

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