[Operative treatment of injuries of the lower cervical spine. Indications and technic for single ventral, dorsal and combined dorsoventral procedures, clinical results].

Since the introduction of osteosynthetic surgery of the vertebral column in our clinic in 1978 we have treated surgically 51 injuries of the lower cervical spine (C3-D1) (1978-end of January 1985). In this article we describe the operative technique with dorsoventral approach and ventral approach alone. We also indicate to the possibility of using the dorsal approach alone. The criterion governing the choice of approach is not the resulting stability, but the pathological anatomy of the vertebral column ventrally and dorsally, and the reducibility of the dislocation, especially in the case of old injuries. The results are reported. In our sample, patients presenting with incomplete radicular and medullary lesions generally recovered, whereas in the group of 12 patients with transverse lesion of the spinal cord with paraplegia only two could be mobilised again. We demonstrated that in transverse lesions of the cord with paraplegia a lowering of the level by one or more segments and an improvement of the radicular neurological deficit can considerably increase the chance that the patient may be able to use his upper extremities again.