The Treatment of Anterior Plating and Posterior Wiring on Lower Cervical Spine Fracture and Dislocation

Ahn, Jae Sung; Lee, June Kyu; Lee, Chang Hwan

Abstract

PURPOSE: Recently, as traffic and industrial accidents increase year by year, so the incidence of fracture and dislocation of the cervical spine tends to increase. The treatment of this condition is controversial. However, there is increasing tendency to stabilize unstable cervical spine injuries surgically. This study was undertaken to retrospectively analyze the results of surgical treatment of lower cervical spine fracture and dislocation, and to suggest a rational treatment method comparing of surgical approach, bone union, neurologic recovery and clinical symptoms. MATERIAL AND METHODS: Authors studied the medical records and roentgenograms of 48 patients, who were treated surgically for acute fracture and dislocation of the lower cervical spine since January, 1993 to April, 1999. 21 patients were treated by anterior plating and 27 patients were by posterior wiring method. 33 male and 15 female with average age of 38.3 years comprised the group. The most common cause of the injury was traffic accident(35 cases-73%). The most common site of injuries was cervical spine 5-6(20 cases-41%). 6 cases were compressive-flexion(C-F) injuries, 4 cases were vertical-compression(V-C) injuries, 22 cases were distractive-flexion(D-F) injuries, 16 cases were distractive-extension(D-E) injuries according to Allen's Classification.
RESULTS
6 C-F injury patients were treated surgically by 4 anterior approach and 2 posterior approach. All 4 V-C injury patients were by anterior approach. 22 D-F injury patients were by 6 anterior approach and 16 posterior approach. 16 D-E injury patients were by 9 anterior approach and 7 posterior approach. There were 95% radiologic bone union rate in anterior approach and 96% in posterior approach. There was no neurologic recovery in complete spinal cord injury and average 1-2 grade of recovery in incomplete and nerve root injury by Frankel's Classification. The postoperative complication were screw loosening in 1 case, instability on near site of the operation in 2 cases, superficial infection in 1 case. SUMMARY AND CONCLUSION: In the treatment of lower cervical spine fracture and dislocation anterior plating and posterior wiring were same results in bone union rate, neurologic recovery and stability. In flexion injuries with posterior disc herniation, posterior wiring by posterior approach could compressing the spinal cord or nerve root thus anterior discectomy and rigid fixation by anterior approach was necessary. In extension injuries with reduced facet joint dislocation by preoperative traction, anterior approach was effective. In combined fracture of posterior arch of cervical spine, it is difficult to operate posterior approach thus anterior approach was effective. Unreduced posterior facet joint by preoperative traction, posterior approach was effective in reduction and fixation.