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

Heui-Jeon Park; Young-Jun Shim

doi:10.4184/jkss.2007.14.4.221

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Park and Shim: Treatment of Distractive Flexion Injury in Lower Cervical Spine using Anterior Cervical Fusion

Original Article

Journal of Korean Spine Surg 2007;14(4):221-228.

Published online: 21 February 2007

DOI: https://doi.org/10.4184/jkss.2007.14.4.221

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

Heui-Jeon Park, M.D., Young-Jun Shim, M.D.

Department of Orthopaedic Surgery Yonsei University, Wonju College of Medicine, Wonju, Korea

Address reprint requests to Heui-Jeon, Park, M.D. Department of orthopaedic Surgery, Wonju College of Medicine, Yonsei University 162 Ilsan-dong, Wonju, Kangwon-do, Korea Tel: 82-33-741-1352, Fax: 82-33-746-7326, E-mail: par73@yonsei.ac.kr

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

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 fre-quent 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.

Keywords: Cervical spine, Distractive flexion injury, Anterior plating

REFERENCES

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Figures and Tables%

Fig. 1.

Radiograph showing linear and angular measurement.

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.

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.

Table 1.

Change of local kyphosis and body height by dislocation type

		Total (n=32)	Unilateral dislocation (n=21)	Bilateral dislocation (n=11)	P-value
	Post op.	5.11	4.31	6.6
Kyphotic angle(。)	Last F/U	4.74	4.41	5.36
	Change of angle (△)	-0.37	0.1	-1.27	0.498
	Post op.	43.9	42.5	46.4
Ant. body height (mm)	Last F/U	41.7	39.6	45.8
	Change of Ht (△)	-2.1	-2.9	-0.6	0.797
	Post op.	43.0	41.8	45.4
Post. body height (mm)	Last F/U	40.8	39.0	44.1
	Change of Ht (△)	-2.3	-2.8	-0.1	0.085

Table 2.

Change of local kyphosis and body height by injury level

	injury level			Total (n=32)	P-value
	C4/5 (C3/4)(n=8)	C5/6 (n=13)	C6/7 (C7/T1) (n=11)	Total (n=32)	P-value
Change of Kyphotic angle (。)	+1.3	-1.9	+0.3	-0.37	0.069
Change of Anterior vertebral body Height (cm)	-0.2	-0.2	-0.3	-0.2	0.598
Change of Posterior vertebral body height (cm)	-0.2	-0.3	-0.2	-0.2	0.879

Table 3.

Relationship between disc herniation and type of dislocation

	Normal Disc	Disc Herniatiobn	Total
Unilateral dislocation	3	18	21
Bilateral dislocation	6	15	11
total	9	23	32

^# Chi-Square test: P=0.016, Fisher test: P=0.035

Table 4.

Change of Neurological Examination

		Herniated Disc(n=23)	Non-herniated Disc (n=9) P-value
	Initial	55.2	55.1
ASIA score	Last F/U	67.1	71.3
	Change of score (△)	11.9	16.2 0.420

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