Lower Cervical Fracture and Dislocations

Abstract

Objectives: The aim of our study is to determine the outcome of cervical pediclescrew fixation for fractures/dislocations of the cervical spine at our set up in Karachi, Pakistan.Study Design: A prospective case series. Period: 04 years duration from January 2013 toDecember 2016. Setting: Tertiary Care Centre in Karachi, Pakistan. Method: All the patientswho were included in the study signed a full informed consent. The inclusion criterion was allthe patients who cervical spine fracture/dislocation, presented to us within 24 hours of injuryand were operated at our set up. Data was collected in a predesigned proforma which includeda complete history and physical examination, age, gender, cause of injury, co morbidities, preoperativeradiological findings, past medical and surgical history. Serial X rays, MRI and CTscans were taken at 3, 6, 12 and 24 months post operatively for evaluation of stability, fusion andany complication such as deformity. The American Spinal Cord Injury Association impairmentscale was utilized in all the patients at follow ups to determine the sensory and motor functionimprovement post operatively. Data was analyzed using IBM SPSS for windows version 21.Results: The study population consisted of n= 40 patients of which n= 28 were male andn= 12 were female with a mean age of 45.2 years. The various types of injuries sustained bythe patients were as follows, n= 6 (15%) cases of cases had compression fractures (vertical),n=15 (37.5%) had flexion rotation injury and n=19 (47.5%) had flexion compression fracturesrespectively. While the division of bony injuries in the patient was as follows, n=5 (12.5%) hadcervical spinal burst fracture with dislocation, n= 15 (37.5%) patients had joint facet fracturewith dislocation bilaterally along with compression fracture of the vertebral body, n= 14 (35%)patients had facet joint fracture with dislocation bilaterally and n= 6 (15%) had unilateral fracturedislocation of joint facet. Complications such as injury to the vertebral artery, spinal cord, nerveroot were not observed in any of the patients in this series, all the patients achieved full bonyfusion at the 6 month follow up as observed on radiographic images. We also did not find anyincidence of screw penetration into the pedicle, similarly no incidence of screw breakage orloosening was observed. N=24 patients with incomplete injury of the spinal cord showedimprovements in their ASIA impairment scale, the patients n= 15 who had a complete spinalcord injury failed to show any improvement post operatively, but reported some decrease in painand numbness post operatively. Conclusion: For fractures/dislocations of the cervical spine thecervical pedicle screw is a reliable and effective method and provides good stability and bonyfusion. However the technique is dependent on surgeons experience and the extensive use ofpre-operative imaging to select the best insertion site of the screws as individualized for everypatient accordingly.