Anterior cervical discectomy and fusion with structural allograft and plates for the treatment of unstable posterior cervical spine injuries

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>The purpose of this study was to evaluate complications and radiographic and functional outcomes of isolated anterior stabilization surgery in which structural allograft and plates were used for posterior unstable subaxial cervical spine lateral mass, facet, and ligamentous injuries.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>Between August 2003 and January 2008, 19 consecutive patients with unstable lateral mass, facet, and/or posterior ligamentous injuries of the subaxial cervical spine were treated by a single surgeon via an anterior approach. This was performed using structural allograft and plate fixation. Patients with any associated anterior vertebral fractures were excluded from the study. Autogenous bone grafts or bone graft substitutes were not used in any patient. The average age of the patients was 43 years (range 17–87 years) and the mean follow-up period was 20.4 months (range 6–48 months). Seventeen of the 19 patients participated in the study; the other 2 were lost to follow-up. Operative times, estimated blood loss, length of hospital stay (LOS), and perioperative complications were recorded for each patient. Radiographic outcomes included fusion scores and sagittal alignment measurements. Outcome scores with respect to neck pain, satisfaction with surgery, and function were recorded for each patient according to analog pain and satisfaction scales and the Neck Disability Index (NDI). Additionally, NDI and pain scores at final follow-up were compared with a group of healthy, age-matched controls.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>The average surgical time was 60 minutes (range 28–108 minutes), and the estimated blood loss averaged 48.9 ml per surgical procedure (range 20–150 ml). The LOS for the 13 patients who had no other associated injuries averaged 2.2 days (range 2–3 days). Fifteen of 17 patients achieved solid radiographic fusion, and no patient demonstrated instability. Only 1 patient had significant loss of the initial sagittal alignment correction at final follow-up. The average NDI score for the 17 patients was 6.5 (range 0–11), indicating mild disability and comparing favorably to a group of healthy age-matched controls. There was no statistical difference in pain scores for the trauma patients and control group at ultimate follow-up (1.5 vs 0.3, respectively). Satisfaction scores for the 17 trauma patients were high, averaging 94% (range 80–100%). Ten of the 11 patients with preoperative radiculopathy demonstrated complete resolution of this condition. Complications occurred in 1 patient with transient hoarseness and 1 with transient swallowing difficulty. There were no wound complications. Screw breakage occurred in 1 patient, and an additional patient required revision surgery for pseudarthrosis.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Anterior cervical discectomy and fusion performed using interbody structural allograft and plate fixation is highly effective in the treatment of unstable posterior cervical lateral mass, facet, and ligamentous injuries. This treatment option results in low intraoperative blood loss, short operating times, and a brief LOS. Radiographic outcomes with respect to segmental stability are excellent, and fusion rates with the use of structural allograft alone are high. Outcomes with respect to pain, function, and patient satisfaction are high, and complications are acceptably low.</jats:p></jats:sec>

Posttraumatic Kyphotic Deformity of the Cervical Spine

“…Woodworth et al report that 1 of 17 (5.8%) patients with posterior ligamentous injury treated with ACDF went on to a progressive kyphotic deformity. 12 The patient remained neurologically intact and fused in a kyphotic position and required no further treatment. In a retrospective review of patients who underwent treatment for flexion distraction injuries, Johnson et nal cord.…”

Biomechanical evaluation of the impact of various facet joint lesions on the primary stability of anterior plate fixation in cervical dislocation injuries: a cadaver study

“…There is still a lack of guidance for using the anterior, posterior, or combined surgical procedures. 34 Historically, surgical treatment was performed using posterior interspinous or 18 Several studies have also reported good clinical outcomes and high fusion rates in association with anterior discectomy, fusion, and plate fixation. 18 Kwon et al reported on a prospective randomized controlled study in which they compared anterior with posterior stabilization for unilateral facet injuries of the cervical spine.…”

“…34 In the Subaxial Injury Classification (SLIC) scale, translation or rotation injuries are assigned the highest number of points (4 points). 32 Significant ligament disruptions are almost always associated with injuries of the subaxial spine.…”

Anterior cervical Corpectomy with cage and plating in subaxial fractures: A review of 20 cases.

“…Whereas most cervical subaxial trauma was treated by posterior approaches in the past, there is now significant evidence suggested that an anterior approach is similarly effective for stabilization. 24 The anterior approach is less traumatic and provides interbody grafting with reconstruction and maintenance of lordosis.…”