title: Anterior Surgical Fixation for Cervical Spine Flexion-Distraction Injuries.
abstract: BACKGROUND
  Optimal surgical management for flexion-distraction cervical spine injuries remains controversial with current guidelines recommending anterior, posterior, and circumferential approaches. Here, we determined the incidence of and examined risk factors for clinical and radiographic failure in patients with 1-segment cervical distraction injuries having undergone anterior surgical fixation.
  
  
  METHODS
  A retrospective review of 57 consecutive patients undergoing anterior fixation for subaxial flexion-distraction cervical injuries between 2008 and 2012 at our institution was performed. The primary outcome was the number of patients requiring additional surgical stabilization and/or radiographic failure. Data collected included age, gender, mechanism and level of injury, facet pattern injury, and vertebral end plate fracture.
  
  
  RESULTS
  A total of 6 patients failed clinically and/or radiographically (11%). Four patients (7%) required additional posterior fixation. Although 2 other patients identified met radiographic failure criteria, at follow-up they had fused radiographically, were stable clinically, and no further treatment was pursued. Progressive kyphosis and translation were found to be significantly correlated with need for revision (P < 0.05 and P = 0.02, respectively). No differences were identified for all other clinical and radiologic factors assessed, including unilateral or bilateral facet injury, facet fracture, and end plate fracture.
  
  
  CONCLUSIONS
  This study contributes to the growing body of evidence supporting anterior fixation alone for flexion-distraction injuries. Findings suggest that current measurements of radiographic failure including segmental translation and kyphosis may predict radiographic failure and need for further surgical stabilization in some patients. Future follow-up studies assessing for independent risk factors for anterior approach failure with a validated predictive scoring model should be considered.
authors.affiliation: Division of Neurosurgery, Department of Surgery, University of Alberta Hospital, Edmonton, Alberta, Canada. Electronic address: asjack@ualberta.ca.
authors.forename: Andrew
authors.initials: A
authors.lastname: Jack
authors.affiliation: Division of Neurosurgery, Department of Surgery, University of Alberta Hospital, Edmonton, Alberta, Canada.
authors.forename: Godefroy
authors.initials: G
authors.lastname: Hardy-St-Pierre
authors.affiliation: Department of Radiology and Diagnostic Imaging, University of Alberta Hospital, Edmonton, Alberta, Canada.
authors.forename: Mitchell
authors.initials: M
authors.lastname: Wilson
authors.affiliation: Division of Neurosurgery, Department of Surgery, University of Alberta Hospital, Edmonton, Alberta, Canada.
authors.forename: Godwin
authors.initials: G
authors.lastname: Choy
authors.affiliation: Division of Neurosurgery, Department of Surgery, University of Alberta Hospital, Edmonton, Alberta, Canada.
authors.forename: Richard
authors.initials: R
authors.lastname: Fox
authors.affiliation: Division of Neurosurgery, Department of Surgery, University of Alberta Hospital, Edmonton, Alberta, Canada.
authors.forename: Andrew
authors.initials: A
authors.lastname: Nataraj
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging* / Q000293:injuries / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000295:instrumentation / Q000379:methods*; D012189:Retrospective Studies; D013124:Spinal Injuries / Q000000981:diagnostic imaging* / Q000601:surgery*; D053831:Surgical Fixation Devices; D055815:Young Adult
keywords: Anterior cervical diskectomy and fusion; Cervical spine; Facet subluxation; Flexion-distraction; Spinal cord injury; Vertebral fracture