Delayed Diagnosed Stage 1, 2 Distractive Flexion Injury of the Cervical Spine

Abstract

Study DesignRetrospective study.PurposeTo examine the clinical and radiologic characteristics of patients with stage 1 and 2 distractive flexion injury according to Allen's classification and who were not diagnosed immediately after injury, and to analyze the outcomes of surgical treatments.Overview of LiteratureFor the diagnosis of stage 1 and 2 distractive flexion injury in the lower cervical spine, attention should be paid when performing radiographs as well as when interpreting the radiographs.MethodsThe study was conducted on 10 patients (group 1) with stage 1 or 2 distractive flexion injury and who were not diagnosed immediately after injury from January 2003 to January 2009. The control group (group 2), 16 distractive flexion injury patients who were diagnosed immediately were selected. The simple radiographs, the degree of soft tissue swelling and the magnetic resonance imaging findings of the two groups were compared, and the clinical and radiologic results were examined.ResultsThe degree of the prevertebral soft tissue swelling of group 1 was lower in group 1, and it was statistically significant (p = 0.046). The fusion was achieved in all cases (100%) in group 1, however, re-displacement as well as the loss of reduction occurred in one case, despite of delayed fusion and good clinical result. In group 2, bone fusion was achieved in 15 cases of 16 cases (94%).ConclusionsFor the diagnosis of stage 1 and 2 distractive flexion injury in the lower cervical spine, it is desirable to perform computed tomography if diagnosis is not clear. Even if the diagnosis is delayed, stage 1 and 2 distractive flexion injury could be readily reduced by traction, and the treatment outcomes are considered to be comparable to those of the patients diagnosed immediately after injury.

Risk factors and surgical approaches in neglected subaxial cervical spine fractures‐dislocations: Experiences with two cases and literature review

“…4 These injuries often lead to neurological deficits, chronic pain, and cervical deformity. 5,6 There is no clear approach for treatment of neglected subaxial fracture-dislocation in guidelines, 7,8 but a few literatures have suggested algorithms to obtain maximum alignment and resolve neurological symptoms. 2,7,9,10 Several surgical strategies such as single anterior, 6 single posterior, 11 posterior-anterior, [12][13][14][15] posterior-anteriorposterior, 7,16 and anterior-posterior-anterior-posterior 7 approaches have been reported but more studies are needed to conclude a definite protocol.…”

“…5,6 There is no clear approach for treatment of neglected subaxial fracture-dislocation in guidelines, 7,8 but a few literatures have suggested algorithms to obtain maximum alignment and resolve neurological symptoms. 2,7,9,10 Several surgical strategies such as single anterior, 6 single posterior, 11 posterior-anterior, [12][13][14][15] posterior-anteriorposterior, 7,16 and anterior-posterior-anterior-posterior 7 approaches have been reported but more studies are needed to conclude a definite protocol. We report our experience of surgical strategies of two patients with neglected subaxial cervical spine fracture-dislocation that came to our center with subsequent follow-ups.…”

“…If the correct diagnosis occurs after 3 weeks of injury, it is considered as a delayed (neglected) subaxial cervical spine fracture‐dislocation 4 . These injuries often lead to neurological deficits, chronic pain, and cervical deformity 5,6 . There is no clear approach for treatment of neglected subaxial fracture‐dislocation in guidelines, 7,8 but a few literatures have suggested algorithms to obtain maximum alignment and resolve neurological symptoms 2,7,9,10 .…”

Neglected dislocation in sub-axial cervical spine: Case series and a suggested treatment protocol

“…[ 1 ] Often these injuries cannot be treated with conventional surgical techniques and require innovative ideas. Various approaches have been suggested for the treatment of neglected dislocations in the subaxial cervical spine (SACS) including only anterior approach,[ 2 ] only posterior approach,[ 3 ] posterior-anterior approach,[ 4 5 6 7 ] posterior-anterior-posterior[ 8 9 ] approach, and anterior-posterior-anterior-posterior[ 8 ] approach. No protocol suggested in literature to guide spine surgeons while treating neglected dislocations of SACS.…”