Distractive Flexion Injuries of the Subaxial Cervical Spine Treated With Anterior Plate Alone

The clinical and radiographic effect of anterior plate fixation alone was evaluated in 36 consecutive patients with distractive flexion (DF) injuries in the lower cervical spine. Mean follow-up time was 15 months. The aim of the present study was to determine whether anterior plate fixation alone provides sufficient stability when treating DF injuries in the cervical spine. Solid union was seen in 6 of 6 patients with stage 1 injury and in 15 of 17 patients with stage 2 injury. In the patients with stage 3 injury, 7 of 13 of the anterior fixations failed. These failures occurred mainly among the patients with severe neurologic injuries. We believe these findings substantiate the use of anterior plate alone for DF injuries at stage 1 and 2 but disqualify anterior plate fixation alone for DF injuries at stage 3, with neurologic injury present.

[1]  R. Waters,et al.  International Standards for Neurological and Functional Classification of Spinal Cord Injury , 1997, Spinal Cord.

[2]  T. Albert,et al.  Magnetic Resonance Imaging Analysis of Soft Tissue Disruption After Flexion-Distraction Injuries of the Subaxial Cervical Spine , 2001, Spine.

[3]  H. Jónsson,et al.  Compression of the cervical spine cord after reduction of fracture dislocations. Report of 2 cases. , 1991, Acta orthopaedica Scandinavica.

[4]  W Caspar,et al.  Anterior cervical fusion and Caspar plate stabilization for cervical trauma. , 1989, Neurosurgery.

[5]  P. McAfee,et al.  A Biomechanical Evaluation of Cervical Spinal Stabilization Methods in a Bovine Model: Static and Cyclical Loading , 1988, Spine.

[6]  L. Brandt,et al.  Fusion or stabilization alone for acute distractive flexion injuries in the mid to lower cervical spine? , 2005, European Spine Journal.

[7]  N. Berrington,et al.  Cervical intervertebral disc prolapse associated with traumatic facet dislocations. , 1993, Surgical neurology.

[8]  M. Arand,et al.  Internal fixation on the lower cervical spine – biomechanics and clinical practice of procedures and implants , 2001, European Spine Journal.

[9]  M. O. al Baz,et al.  Modified Technique of Tension Band Wiring in Flexion Injuries of the Middle and Lower Cervical Spine , 1995, Spine.

[10]  F. Calenbergh,et al.  Long-term results after anterior cervical fusion and osteosynthetic stabilization for fractures and/or dislocations of the cervical spine. , 1995, Journal of spinal disorders.

[11]  F. Kummer,et al.  Internal fixation of cervical trauma following corpectomy and reconstruction. The effects of posterior element injury. , 2000, Bulletin (Hospital for Joint Diseases (New York, N.Y.)).

[12]  L. Brandt,et al.  Posterior Wiring Without Bony Fusion in Traumatic Distractive Flexion Injuries of the Mid to Lower Cervical Spine: Long‐Term Follow‐Up in 30 Patients , 1991, Spine.

[13]  M. Panjabi,et al.  Stabilizing potential of anterior cervical plates in multilevel corpectomies. , 1999, Spine.

[14]  T. Ryken,et al.  Radiographic Assessment of the Cervical Spine in Symptomatic Trauma Patients. , 2002, Neurosurgery.

[15]  P. McAfee,et al.  Biomechanical Evaluation of Cervical Spinal Stabilization Methods in a Human Cadaveric Model , 1989, Spine.

[16]  S. Verbeke,et al.  Treatment of unstable fractures, dislocations and fracture-dislocations of the cervical spine with Senegas plate fixation. , 1994, Acta orthopaedica Belgica.

[17]  R. Kalff,et al.  Operative spondylodesis in injuries of the lower cervical spine , 2004, Neurosurgical Review.

[18]  W. Rauschning,et al.  Locking screw-plate fixation of cervical spine fractures with and without ancillary posterior plating , 2004, Archives of Orthopaedic and Trauma Surgery.

[19]  A. Vaccaro,et al.  Cervical trauma: rationale for selecting the appropriate fusion technique. , 1998, The Orthopedic clinics of North America.

[20]  J. Lazennec,et al.  Severe hyperflexion sprains of the lower cervical spine in adults. , 1999, Clinical orthopaedics and related research.

[21]  G. Saillant,et al.  Treatment of Lower Cervical Spinal Injuries—C3 to C7 , 1992, Spine.

[22]  R. Lifeso,et al.  Anterior Fusion for Rotationally Unstable Cervical Spine Fractures , 2000, Spine.

[23]  A. Vaccaro,et al.  In Vitro Genesis of Subaxial Cervical Unilateral Facet Dislocations Through Sequential Soft Tissue Ablation , 2001, Spine.

[24]  B L Currier,et al.  Biomechanical Evaluation of Anterior Cervical Spine Stabilization , 1998, Spine.

[25]  B. A. Green,et al.  Extrusion of an intervertebral disc associated with traumatic subluxation or dislocation of cervical facets. Case report. , 1991, The Journal of bone and joint surgery. American volume.

[26]  T. Ducker,et al.  Magnetic resonance imaging documentation of coexistent traumatic locked facets of the cervical spine and disc herniation. , 1993, Journal of neurosurgery.

[27]  T. B. Barros Filho,et al.  Corpectomy and anterior plating in cervical spine fractures with tetraplegia. , 1993, Revista paulista de medicina.

[28]  D. Gaieski,et al.  Utility of flexion and extension radiographs of the cervical spine in the acute evaluation of blunt trauma. , 2002, The Journal of trauma.

[29]  T. Ryken,et al.  Radiographic Assessment of the Cervical Spine in Asymptomatic Trauma Patients. , 2002, Neurosurgery.

[30]  P. Meyer,et al.  Series of Ninety‐Two Traumatic Cervical Spine Injuries Stabilized with Anterior ASIF Plate Fusion Technique , 1991, Spine.

[31]  E. Zardo,et al.  Soft tissue injuries associated with traumatic locked facets in the cervical spine , 1995, Paraplegia.

[32]  B. Cunningham,et al.  In Vitro Biomechanical Comparison of Multistrand Cables With Conventional Cervical Stabilization , 1996, Spine.

[33]  J. Sénégas,et al.  Reduction Technique for Uni‐ and Biarticular Dislocations of the Lower Cervical Spine , 1998, Spine.

[34]  S. Rao,et al.  Pitfalls in the surgical management of cervical spine injuries , 2004, European Spine Journal.

[35]  F. Kummer,et al.  The effect of locking fixation screws on the stability of anterior cervical plating. , 1999, Spine.

[36]  J. Doniec,et al.  Results of conservative treatment of unilateral cervical spine dislocations , 2004, Archives of Orthopaedic and Trauma Surgery.

[37]  P. Anderson,et al.  Classification of Lower Cervical Spine Injuries , 2006, Spine.

[38]  N M Gajraj,et al.  Cervical spine stabilization. , 1994, Anesthesiology.

[39]  J. Zigler,et al.  Cervical spine fusions for trauma. A long-term radiographic and clinical evaluation. , 1994, Orthopaedic review.

[40]  B. Allen,et al.  A Mechanistic Classification of Closed, Indirect Fractures and Dislocations of the Lower Cervical Spine , 1982, Spine.

[41]  D. Devito,et al.  Circumferential fusion for the management of acute cervical spine trauma. , 1991, Journal of spinal disorders.

[42]  G. Cybulski,et al.  Complications in Three-Column Cervical Spine Injuries Requiring Anterior–Posterior Stabilization , 1992, Spine.

[43]  R. Balderston,et al.  Magnetic resonance evaluation of the intervertebral disc, spinal ligaments, and spinal cord before and after closed traction reduction of cervical spine dislocations. , 1999, Spine.

[44]  Alexander R. Vaccaro,et al.  Cervical spine trauma , 2016 .

[45]  M. Aebi,et al.  Treatment of Cervical Spine Injuries with Anterior Plating: Indications, Techniques, and Results , 1991, Spine.

[46]  J. Webb,et al.  Hidden flexion injury of the cervical spine. , 1976, The Journal of bone and joint surgery. British volume.

[47]  S. Govender,et al.  The triple wire technique for bifacet dislocation of the cervical spine. , 1997, Injury.