Anterior Cervical Discectomy and Fusion With a Locked Plate and Wedged Graft Effectively Stabilizes Flexion-Distraction Stage-3 Injury in the Lower Cervical Spine

Paxinos, Odysseas; Ghanayem, Alexander J.; Zindrick, Michael R.; Voronov, Leonard I.; Havey, Robert M.; Carandang, Gerard; Hadjipavlou, Alexander; Patwardhan, Avinash G.

doi:10.1097/brs.0b013e318188386a

Cited by 31 publications

(16 citation statements)

References 42 publications

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“…We have almost always encountered grossly disrupted discs during anterior surgery; therefore, we prefer the anterior approach. Biomechanical investigations have demonstrated that ACDF with plating can effectively stabilize the non-osteoporotic cervical spine after complete posterior element injury19). In this study, all patients underwent successful reduction and stabilization through the anterior approach, and there was no instability at the last follow-up.…”

Section: Discussionmentioning

confidence: 70%

Polyetheretherketone Cage with Demineralized Bone Matrix Can Replace Iliac Crest Autografts for Anterior Cervical Discectomy and Fusion in Subaxial Cervical Spine Injuries

Kim

Lee

Jang

et al. 2017

J Korean Neurosurg Soc

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ObjectiveThis study aimed to compare the clinical and radiologic outcomes of patients with subaxial cervical injury who underwent anterior cervical discectomy and fusion (ACDF) with autologous iliac bone graft or polyetheretherketone (PEEK) cages using demineralized bone matrix (DBM).MethodsFrom January 2005 to December 2010, 70 patients who underwent one-level ACDF with plate fixation for post-traumatic subaxial cervical spinal injury in a single institution were retrospectively investigated. Autologous iliac crest grafts were used in 33 patients (Group I), whereas 37 patients underwent ACDF using a PEEK cage filled with DBM (Group II). Plain radiographs were used to assess bone fusion, interbody height (IBH), segmental angle (SA), overall cervical sagittal alignment (CSA, C2–7 angle), and development of adjacent segmental degeneration (ASD). Clinical outcome was assessed using a visual analog scale (VAS) for pain and Frankel grade.ResultsThe mean follow-up duration for patients in Group I and Group II was 28.9 and 25.4 months, respectively. All patients from both groups achieved solid fusion during the follow-up period. The IBH and SA of the fused segment and CSA in Group II were better maintained during the follow-up period. Nine patients in Group I and two patients in Group II developed radiologic ASD. There were no statistically significant differences in the VAS score and Frankel grade between the groups.ConclusionThis study showed that PEEK cage filled with DBM, and plate fixation is at least as safe and effective as ACDF using autograft, with good maintenance of cervical alignment. With advantages such as no donor site morbidity and no graft-related complications, PEEK cage filled with DBM, and plate fixation provide a promising surgical option for treating traumatic subaxial cervical spine injuries.

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Section: Discussionmentioning

confidence: 70%

Polyetheretherketone Cage with Demineralized Bone Matrix Can Replace Iliac Crest Autografts for Anterior Cervical Discectomy and Fusion in Subaxial Cervical Spine Injuries

Kim

Lee

Jang

et al. 2017

J Korean Neurosurg Soc

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“…Highly detrimental effects are expected in such a severe compression, but this case presented an unusual sparing of the upper limbs, and the patient was totally continent throughout while his lower limbs displayed significant symptoms secondary to compression. Bilateral facet dislocation of C4 through C7 creates instability and frequently is associated with quadriplegia [14]. The sparing of the upper limbs indicates that, even with 70% subluxation, injury to the cord and nerve roots was incomplete.…”

Section: Discussionmentioning

confidence: 99%

Delayed diagnosis of post-traumatic C7 vertebra anterior subluxation with an unusual neurological pattern: a case report

et al. 2013

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IntroductionPost-traumatic subluxations are potentially devastating injuries to the axial skeleton. Of utmost priority are an expedient and timely diagnosis and realignment because of its association with spinal cord and nerve root trauma, which lead to progressive deleterious neurological deficits. A good radiological study of the occipitocervical joint and first thoracic vertebra is key to a successful early diagnosis. However, cases might still fail to be diagnosed, leading to trouble. A case of post-traumatic subluxation at the C7 vertebral level with an unusual neurological pattern is presented here.Case presentationA 35-year-old farmer from the Sindh province of Pakistan presented to our neurology department after a fall 2 months earlier and complained of lower limb pain and difficulty in walking. He had numbness in both of his lower limbs up to his umbilical region, with sparing of bladder function along with intact strength in the upper extremities bilaterally.ConclusionsOur case highlights the unusual sparing of upper limbs and intact urinary continence with severe lower limb deficits in a 70% subluxation. Our case is unusual because highly detrimental effects such as quadriplegia are expected with such extreme subluxation, but our patient presented with only lower limb deficits. This case serves as a reminder to emergency medicine doctors, spine surgeons, and even radiologists (a) to evaluate spine injuries by using computed tomography in trauma patients to identify artifact around a suspected injury and (b) to be mindful of negative conventional radiographs.

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“…Posterior fixation provides a more rigid fixation compared to anterior stabilization; however, the rigidity provided by anterior fixation is significantly higher than in an intact motion segment 12. The anterior approach in addition provides direct access to the cord and the compressive elements and has a lower incidence of post-surgical kyphosis 13…”

Section: Discussionmentioning

confidence: 99%

“…More recently, global fusion has been recommended in translation rotational injuries associated with end-plate fractures and burst or tear drop fractures;1215 however good fusion rates (85-90%) have been achieved following anterior fusion and fixation in flexion, distraction, and translation rotational injuries 1216…”

Section: Discussionmentioning

confidence: 99%

Sub-axial cervical spine injuries: Modified Stellerman’s algorithm

Shetty

Kini²,

Muthappa

2011

IJOO

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Background:Global fusion is recommended in sub-axial cervical spine injuries with retrolisthesis, translation rotation injuries associated with end plate or tear drop fractures. We propose a modification of Stellerman’s algorithm which we have used where in patients are primarily treated via anterior decompression and fixation. Global fusion was done only in cases where post-decompression traction does not achieve reduction in cases with locked facets.Materials and Methods:Two hundred and thirty consecutive patients with sub-axial cervical spine injuries were studied in a prospective trial over a 7 year period. Seven cases with posterior compression alone were not subjected to our protocol. Of the other 223 cases, 191 cases who on radiological evaluation needed surgery were initially approached anteriorly. Decompression was effected through a corpectomy in 14 cases and a single or multiple level disc excisions were performed in the others. Cases with cervical listhesis (n=36) where on table reduction could not be achieved following decompression were subjected to progressive skeletal traction for 48 h. Posterior facetectomy and global fixation was done for patients in whom reduction could not be achieved despite post-decompression traction (n=11).Results:Of the 223 cases, 20 cases were managed conservatively, 12 cases expired pre-operatively, and the remaining 191 cases needed surgical intervention. Out of the 154 cases of distraction/rotation/translation injuries on table reduction could be achieved in 118 cases (76.6%). Thirty-six patients had locked facets (23 cases were bifacetal, 13 cases unifacetal) and of these 36 cases reduction could be achieved with post-anterior decompression traction in 25 patients (16.2%); however, only 11 cases (7.1%)–8 bifacetal and 3 unifacetal dislocations–needed posterior facetectomy and global fusion. One hundred and forty-three patients were followed up for a minimum period of 6 months. One hundred and twenty-six patients showed evidence of complete fusion (88.1%) while the remaining 17 (11.8) showed evidence of partial fusion. There were no signs of instability on clinical and radiological evaluation in any of the cases. Reduction of graft height was noted in 18 patients (12.5%). There were eight cases of immediate postoperative mortality and two cases of delayed mortality in our series of cases.Conclusion:We feel that on table decompression and reduction followed by anterior stabilization can be used as the initial surgical approach to manage most types of cervical injuries. In rotation/translational cases where reduction cannot be achieved, monitored cervical traction on the decompressed spine can safely achieve reduction and hence avoid the need for a posterior facetectomy in a large percentage of cases.

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Anterior Cervical Discectomy and Fusion With a Locked Plate and Wedged Graft Effectively Stabilizes Flexion-Distraction Stage-3 Injury in the Lower Cervical Spine

Cited by 31 publications

References 42 publications

Polyetheretherketone Cage with Demineralized Bone Matrix Can Replace Iliac Crest Autografts for Anterior Cervical Discectomy and Fusion in Subaxial Cervical Spine Injuries

Polyetheretherketone Cage with Demineralized Bone Matrix Can Replace Iliac Crest Autografts for Anterior Cervical Discectomy and Fusion in Subaxial Cervical Spine Injuries

Delayed diagnosis of post-traumatic C7 vertebra anterior subluxation with an unusual neurological pattern: a case report

Sub-axial cervical spine injuries: Modified Stellerman’s algorithm

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