Open Access, Peer-reviewed
pISSN 2093-4378
eISSN 2093-4386
    J Korean Soc Spine Surg. 2006 Sep;13(3):163-169. Korean.
    Published online Sep 30, 2006.
    https://doi.org/10.4184/jkss.2006.13.3.163
    Copyright © 2006 Korean Society of Spine Surgery
    Original Article

    Availability of Anterior Cervical Plating in Distractive Flexion Injury in Lower Cervical Spine - Radiologic Aspects -

    Whoan Jeang Kim, M.D., Jong Won Kang, M.D., Jae Guk Park, M.D., Chang Hyun Baik, M.D., Kun Young Park, M.D.,# Joon Hyuk Ko, M.D. and Won Sik Choy, M.D.
      • Department of Orthopaedic Surgery, Eulji University School of Medicine, Daejeon, Korea.
      • #Department of Orthopaedic Surgery, Daejeon Veterans Hospital, Daejeon, Korea.
    • Address reprint requests to: Jong Won Kang, M.D. Department of Orthopaedic Surgery, Eulji University School of Medicine #1306, Dunsan-dong, Seo-gu, Daejon, 302-799, Korea. Tel: 82-42-611-3279, Fax: 82-42-259-1289, Email: jwkang@eulji.ac.kr

    Abstract

    Study Design

    A retrospective clinical and radiological analysis.

    Objectives

    To evaluate the availability of anterior cervical plating in the treatment of distractive-flexion injuries of the lower cervical spine.

    Summary of the Literature Review

    Surgical approaches for distractive-flexion injuries of the lower cervical spine have included the anterior approach, the posterior approach, and the combined anterior and posterior approach. However, which approach is the most useful remains a controversial issue.

    Materials and Methods

    We reviewed the outcomes of 30 patients, who were followed-up for an average of 16 months (range, 12-43 months) after undergoing fusions with anterior cervical plating for distractive-flexion injuries of the lower cervical spine from July 1995 to July 2004. The average age of these patients was 52.9 years (range 24-77 years) and male-to-female ratio was 26:4. Group A consisted of 19 cases that were composed of unilateral dislocations and Group B consisted of 11 cases that were composed of bilateral dislocations based on Allen's classification. Group A1 (9 cases) and B1 (8 cases) were composed of cases that had fractures on the superior end plates or facet joints of the lower cervical spine in each group. Group A2 (10 cases) and B2 (3 cases) were composed of cases without fractures in each group. Neurologic symptoms were evaluated by the Frankel classification; and the angle of lordosis, disc height, and duration of bony union were analyzed postoperatively and with the last follow-up roentgenograms.

    Results

    Clinically, 22 (73%) patients had neurologic deficits, which were composed of 9 (41%) cases of complete injury, 7 (32%)cases of incomplete injury, and 6 (27%) cases of nerve root injury. The nerve root injuries recovered in all cases and the incomplete injuries had an average 1.7 grade recovery by the Frankel classification. Radiologically, the loss of lordosis was 2.2±1.7° in group A, 3.1±2.8° in group B (p=0.359), 3.0±1.6° in group A1, 1.5±1.5° in group A2 p=0.048), 3.5±3.1° in group B1, and 2.1± 1.7° in group B2. Loss of disc height was 1.7±1.1 mm in group A, 2.2±0.9 mm in group B( p=0.201), 2.2±0.9 mm in group A1, 1.2±1.0 mm in group A2 (p=0.046), 2.5±0.6 mm in group B1, and 1.2±1.1 mm in group B2. The duration for bony union was 12.9±2.8 weeks in group A, 14.1±2.7 weeks in group B (p=0.044), 13.9±2.1 weeks in group A1, 11.9±3.0 weeks in group A2 (p=0.046), 14.4±2.9 weeks in group B1, and 13.3±2.3 weeks in group B2. There was no graft displacement, nonunion or metal failure.

    Conclusions

    Anterior cervical plating was an effective treatment modality for distractive-flexion injuries of the lower cervical spine. and more firm method was necessary to surgical treatment in case of fractures on superior end plate or facet joint.

    Keywords
    Lower cervical spine; Distractive-flexion injury; Facet fracture; End plate fracture; Anterior cervical plating

    Figures

    Fig. 1
    Clinical results and Frankel's classification

    Tables

    Table 1
    Radiologic results about loss of lordosis (°), loss of disc height (mm) and duration of bony union (week)

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    MeSH Terms
    Animals
    Classification
    Dislocations
    Follow-Up Studies
    Humans
    Lordosis
    Neurologic Manifestations
    Retrospective Studies
    Spine*
    Transplants
    Zygapophyseal Joint
    Metrics
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