[The selection of the surgical approach in the management of fracture and dislocation of lower cervical spine combined spinal cord injury].
OBJECTIVE
To investigate how to select an appropriate surgical approach in the management of fracture and dislocation of lower cervical spine combined spinal cord injury.


METHODS
The clinical data of 54 patients of lower cervical spine fracture and dislocation were retrospectively analyzed. There were 29 cases with vertebral body compressive fracture and dislocation, 7 cases with vertebral body bursting fracture and dislocation, 3 cases with unilateral facet dislocation, 15 cases with bilateral facet dislocation. All cases were associated with spinal cord injury. According to American Spinal Injury Association (ASIA) grades, 21 cases were in A grade, 5 cases in B grade, 22 cases in C grade and 6 cases in D grade. All patients had surgical reduction, decompression, stabilization and fusion, 43 cases in anterior approach and 11 cases in posterior approach.


RESULTS
All patients were followed up in 12 to 36 months, the mean follow-up time was 18 months. There were no great vessels, trachea, esophagus or spinal cord iatrogenic injury. There were no pull-out and breakage of screws or plates. Fusion was achieved in all patients at an average of 12 weeks postoperatively. There were no pseudarthrosis or bone nonunion. Of all the patients, 96.3% were acquired completely reduction and the normal intervertebral height and lordosis were maintained. Patients with complete spinal cord had no neurologic recovery, but they felt relief from upper limb pain or numb. Incomplete spinal cord lesions improved on average 1-2 Frankel grade after surgery.


CONCLUSIONS
For lower cervical spine fracture and dislocation, an ideal anatomy reduction can be obtained with either anterior or posterior approach surgery. It is important to select a suitable surgical approach according to different types of cervical fracture and dislocation.
Jin
Da-di
DD
Department of Orthopedics and Spine Surgery, Nanfang Hospital, Nanfang Medical University, Guangzhou 510515, China.
Lu
Kai-wu
KW
Wang
Ji-xing
JX
Chen
Jian-ting
JT
Jiang
Jian-ming
JM
D000293:Adolescent; D000328:Adult; D000368:Aged; D002574:Cervical Vertebrae / Q000293:injuries* / Q000601:surgery; D017586:Diskectomy / Q000379:methods; D005260:Female; D006801:Humans; D004204:Joint Dislocations / Q000150:complications / Q000601:surgery*; D007796:Laminectomy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013119:Spinal Cord Injuries / Q000150:complications*; D016103:Spinal Fractures / Q000150:complications / Q000601:surgery*; D013123:Spinal Fusion / Q000379:methods; D016896:Treatment Outcome