[Treatment of lower cervical fracture dislocation by titanium screw-plate internal fixation on cervical lateral mass].

OBJECTIVE

To evaluate surgical results of the titanium screw-plate internal fixation in treatment of the lower cervical fracture dislocation.

METHODS

From September 2001 to March 2006, 31 patients (24 males, 7 females; age range, 20-63 years) with the lower cervical fracture dislocation were treated in our department. The injuries were caused by a road accident in 25 patients, a high crash in 4, and a heavy object crash in 2. The fracture dislocation occurred in the following cervical segments: C3 (1 patient), C1 (5 patients), C5 (12 patients), C6 (10 patients), and C7 (3 patients). The disease course ranged from 1 to 23 days. The associated spinal nerve root injury occurred in 29 patients. The Frankle scaling revealed that 14 patients were at Grade A, 3 at Grade B, 7 at Grade C, 3 at Grade D, and 2 at Grade E (associated nerve root injury with hand and shoulder numbness). The 29 patients underwent the spinal cord decompression, the grafting fusion of the small joints, and the lateral mass titanium screw-plate internal fixation; 2 patients without nerve injury underwent only the grafting fusion of the small joints and the lateral mass titanium screw-plate internal fixation. The bone fusion, cervical vertebra movement, and internal fixation condition were observed by the X-ray examinations postoperatively. The nerve function recovery was evaluated by the Frankle scaling system.

RESULTS

The followed-up in all the patients for 6 months to 4 years revealed that the small joint fusion time was 3-6 months, with an average of 3. 6 months. The cervical X-ray films showed that there was no instability or fracture looseness of the internal fixation at 6 months. Among the 29 patients with the spinal nerve root injury, 14 were at Grade A preoperatively but 13 were improved at Grade B and 1 at Grade C postoperatively; 3 were at Grade B preoperatively but 2 were improved at Grade C and 1 at Grade D postoperatively; 7 were at Grade C preoperatively but 3 were improved at Grade D and 4 at Grade E postoperatively; 3 at Grade D preoperatively but all the 3 were improved at Grade E postoperatively; 2 were at Grade E preoperatively and remained unchanged postoperatively. In the 2 patients with only the nerve root injury, numbness disappeared soon after operation.

CONCLUSION

This posterior approach has two advantages: the mobility range of the cervical vertebra can preserved to the greatest extent because of the short segment fixation; the better stability can obtained because of the titanium screw-plate internal fixation on the cervical joint-column to prevent the hyperextension and hyperflexion. Therefore, the titanium screw-plate internal fixation on the cervical lateral mass is an effective treatment of the lower cervical fracture dislocation.