Tactics and Pitfall in Operation for Patients with Lower Cervical Spine Injury according to Injured Column and Operated Column

Jahng, Tae Ahn; Kim, Jong Moon

Abstract

Operative management using instruments is being used widely for stabilization for the patients with lower cervical spine injuries. Although these instrumentation can fix unstable spine segments firmly, selection and application are not defined clearly in association with injured column. Authors investigated the results of these operation in terms of relationship between injured column and operated column. Eighty five patients were enrolled(male 67, female 18) in this study for the past three years. We applied two-column concept with fiducial line of posterior longitudinal ligament delete Patients were classified into three injured groups based on dynamic X-ray and MRI findings and three operated groups according to operated columns(anterior, posterior, and both). We studied the results with relationships between the respective groups. Anterior approach was performed in all anterior, 2 posterior, and 25 both-column injured patients and 14 patients received both-column operation. Incomplete reduction or malalignment was found in 6 patients. Five of them were both-column injured cases with anterior approach, and 2 of six both-column injured cases on C7-T1 were failed with anterior procedure. There were 7 surgical complications(all in both-column injured cases with one side procedure). Even though both-column injured cases could be managed with anterior procedure only, but it did not afford secure fixation in some cases and might have been associated with complications. Anterior cervical approach has to be performed with consideration of spinal column and level, and circumferential fusion and fixation must be considered in selected both-column injured cases.