Treatment of Cervical Spine Fractures and Subluxations without the Use of Intraoperative Fluoroscopy in Resource-Limited Settings

Abstract

Background Surgical management of subaxial cervical spine injuries remains challenging. Although intraoperative fluoroscopy is usually used for intraoperative spinal level localization (SLL), it is unavailable in most developing countries. The surgeon therefore has to rely on anatomic landmarks. In our setting, in the absence of intraoperative fluoroscopy, we used the carotid tubercle for SLL. Herein we evaluate the accuracy and reliability of the carotid tubercle as a landmark during surgery for traumatic cervical spine injury. Methods This was a retrospective cohort study on 34 patients undergoing anterior cervical surgery for subaxial cervical spine fractures and/or subluxation between January 2005 and February 2011. From their medical records, the patients' sociodemographic, clinical, radiological, and operative data were retrieved and analyzed. Results Thirty-four patients were included in the study. The mean age was 36.2 years. Thirty patients were males. The mean duration between the trauma and surgical intervention was 9.6 days. Six patients were completely tetraplegic. Fourteen patients had fractures and 20 patients had subluxation. The carotid tubercle was palpable in all the 34 cases. Twenty-two (68.8%) patients had partial or complete neurologic recovery. Complete anatomic reduction was achieved in 30 cases. One case of slight malalignment of the plate was observed. No case of significant deviation nor penetration of the screw into the vertebral canal was found. One patient died. Conclusions Carotid tubercle, a palpable intrinsic marker, is an attractive anatomic landmark for SLL during surgeries for traumatic spine injuries in resource-limited settings.