Lower Cervical Fracture and Dislocations

Abstract

ABSTRACT… Objectives:The aim of our study is to determine the outcome of cervical pedicle screw 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 to December 2016. Setting: Tertiary Care Centre in Karachi, Pakistan. Method: All the patients who were included in the study signed a full informed consent. The inclusion criterion was all the patients who cervical spine fracture/dislocation, presented to us within 24 hours of injury and were operated at our set up. Data was collected in a predesigned proforma which included a complete history and physical examination, age, gender, cause of injury, co morbidities, preoperative radiological findings, past medical and surgical history. Serial X rays, MRI and CT scans were taken at 3, 6, 12 and 24 months post operatively for evaluation of stability, fusion and any complication such as deformity. The American Spinal Cord Injury Association impairment scale was utilized in all the patients at follow ups to determine the sensory and motor function improvement 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 and n= 12 were female with a mean age of 45.2 years. The various types of injuries sustained by the 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 fractures respectively. While the division of bony injuries in the patient was as follows, n=5 (12.5%) had cervical spinal burst fracture with dislocation, n= 15 (37.5%) patients had joint facet fracture with 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 fracture dislocation of joint facet. Complications such as injury to the vertebral artery, spinal cord, nerve root were not observed in any of the patients in this series, all the patients achieved full bony fusion at the 6 month follow up as observed on radiographic images. We also did not find any incidence of screw penetration into the pedicle, similarly no incidence of screw breakage or loosening was observed. N=24 patients with incomplete injury of the spinal cord showed improvements in their ASIA impairment scale, the patients n= 15 who had a complete spinal cord injury failed to show any improvement post operatively, but reported some decrease in pain and numbness post operatively. Conclusion: For fractures/dislocations of the cervical spine the cervical pedicle screw is a reliable and effective method and provides good stability and bony fusion. However the technique is dependent on surgeons experience and the extensive use of pre-operative imaging to select the best insertion site of the screws as individualized for every patient accordingly. Key words:Cervical Spine; Dislocati...