[EFFECTIVENESS AND SAFETY OF SIMPLY ANTERIOR APPROACH FOR LOWER CERVICAL SPINE FRACTURE DISLOCATION (Allen-Ferguson II OR III TYPE) WITHOUT SPINAL CORD INJURY].

OBJECTIVE

To study the effectiveness and safety of simply anterior approach for lower cervical spine fracture dislocation (Allen-Ferguson II or III type) without spinal cord injury.

METHODS

Twenty-five patients with lower cervical spine fracture dislocation (Allen-Ferguson II or III type) without spinal cord injury were treated between June 2013 and June 2015. There were 17 males and 8 females with an average age of 41.2 years (range, 31-57 years). Injury was caused by falling from height in 11 cases, by bruise in 5 cases, by crash of heavy object in 6 cases, and by traffic accident in 3 cases. There were 24 cases of fresh fractures and 1 case of old fracture. According to the Frankel grading criteria, 19 cases were rated as grade E and 6 cases as grade D. The injured levels included C4, 5 in 5 cases, C5, 6 in 14 cases, and C6, 7 in 6 cases. Unilateral locked-facet joint was observed in 9 cases, and bilateral locked-facet joint in 16 cases. The operation time, intraoperative blood loss, and surgical complications were recorded; the Odom standard was used to evaluate the effectiveness. The Cobb angle and D-value (the degree of cervical kyphosis or lordosis) were measured on the X-ray film, the bone graft fusion rate was recorded.

RESULTS

The operation was successfully completed in 25 patients; the operation time was 66 to 115 minutes, the intraoperative blood loss was 80 to 220 mL. The postoperative follow-up time was 12 to 36 months (mean, 19.3 months). Postoperative temporary dysphagia occurred in 1 case, and pain at donor site in 2 cases; there were no complications of spinal cord injury, hematoma, hoarse, and esophageal fistula. The nerve function was improved from preoperative grade D to postoperative grade E at 3 months. The X-ray films showed bone graft fusion; there was no loss of intervertebral height or loosening of internal fixation. At 3 months after operation, the effectiveness was excellent in 18 cases, good in 6 cases, and fair in 1 case, and the excellent and good rate was 96.0%. The postoperative Cobb angle and the D value were significantly improved when compared with preoperative ones (P<0.05).

CONCLUSIONS

Simple anterior approach has the advantages of good effectiveness, small trauma, and fast recovery for treating lower cervical spine fracture dislocation (Allen-Ferguson II or III type) without spinal cord injury.