Immediate reduction under general anesthesia and combined anterior and posterior fusion in the treatment of distraction-flexion injury in the lower cervical spine

Abstract

Background: Distraction-flexion of the lower cervical spine is a severe traumatic lesion, frequently resulting in paralysis. The optimal surgical treatment is controversial. It has been a challenge for orthopedic surgeons to manage distraction-flexion injury in the lower cervical spine while avoiding the risk of iatrogenic damage. Thus, safer strategies need to be designed and adopted.This study aimed to evaluate the clinical efficacy of immediate reduction under general anesthesia and combined anterior and posterior fusion in the treatment of distraction-flexion injury in the lower cervical spine. Methods: Twenty-four subjects of traumatic lower cervical spinal distraction-flexion were retrospectively analyzed from January 2010 to December 2013. Traffic accident was the primary cause of injury, with patients presenting with dislocated segments in C4-5 (n=8), C5-6 (n=10), and C6-7 (n=6). Sixteen patients had unilateral facet dislocation and eight had bilateral facet dislocation. Spinal injuries were classified according to the American Spinal Injury Association (ASIA) impairment scale (2000 edition amended), with four cases of grade A, four cases of grade B, ten cases of grade C, four cases of grade D, and two cases of grade E. On admission, all patients underwent immediate reduction under general anesthesia and combined anterior and posterior fusion. The mean follow-up time was 3.5 years. Results: All operations were completed successfully, with no major complications. Postoperative X-rays showed satisfactory height for the cervical intervertebral space and recovery of the vertebral sequence. Bone fusion was completed within 4 to 6 months after surgery. Surgery also significantly improved neurological function in all patients. Conclusion: Immediate reduction under general anesthesia and combined anterior and posterior fusion can be used to successfully treat distraction-flexion injury in the lower cervical spine, obtaining completed decompression, safe spinal re-alignment, and excellent immediate postoperative stability.