Anterior Stabilization in Cervical Spine Fractures

A Dismal Image  Cord injury not treatable still  Unpredictable outcome  Prolonged course of treatment  Psychosocial factors Commonest and most devastating injury of axial skeleton

Spinal cord injuries  Constitute 2-5 % of all blunt trauma  cases / million  40 % of cervical spine injuries have cord involvement  Cost factor

Goals of treatment  To realign the spine  To prevent loss of function in uninjured neural tissue  To improve neurological recovery  To obtain early functional recovery  To obtain and maintain spinal stability

Indications  Instability  Decompression  Stabilization Anterior posterior

Instability  Loss of ability of the spine to maintain relation ship between vertebrae  White and Punjabi- 2 column concept  Dennis- 3 column concept  Radiological evidence Translation 3.5 mm Angulation 11 degrees Widening of inter spinous distance

Anterior Approach Advantages  Easy positioning  Easy removal of disc  Less invasive  Less chances for kyphosis or disc degeneration  Simple technique under direct vision  Enables compression of the graft  Rigid immobilization

Anterior plating Disadvantages  Possibility of loosening  Chances of infection  Possibility of neurological injury  Chances of fistula formation  Not possible in unreduced facet dislocation

Historical back ground  Considered in the past as a “disease not to be treated”  Crutchfield traction in1933  Halo vest Nickel and Perry1950  Operative stabilization Harda1891  Posterior plating-Roy-Camille1964  Anterior approach Cloward1953

Khoula experience

Initial management steps  Haemodynamic stabilization  Cervical collar  X-ray  CT scan  MRI  Steroids

 Traction  Secondary exam  ICU admission  Prevention of DVT  Physiotherapy Initial management steps

Surgical Procedure

Anatomy

Types of plates

A retrospective study 32 cases

Demographic pattern 10 – 20 years5 21 – 30 years15 31 – 40 years7 Above 405 Male28 Female4 SEX AGE

Cause of injury RTA25 Domestic Fall2 Fall from tree5

DislocationC3-C4 2 C4-C5 7 C5-C6 7 DISLOCATIONC FRACTURE C4 1 Fracture C5 3 Level of injury Fracture C6 1 FRACTURE C7 3 FRACTURE C4AND C5 1 Fracture C5 and C6 1 Fracture C6 and C7 3

Corpectomy 13 C4 1 C5 3 C6 1 C7 3 C4-C5 1 C5-C6 1 C6-C7 3 C3-C41 C4-C59 C5-C66 C6-C73 Discectomy 19

Associated injuries Lumbar spine 3 Fracture femur 2 Fracture humerus 1 Chest injuries 3 Trauma abdomen 1 Scalp avulsion 1

Neurological Status Frankel A19 B1 C3 D2 E7 B to D1 C to D 2 C to E 1 D to E 1 IMPROVEMENTSTATUS

Timing of surgery Less than three days 3 More than three days 29 Range 1-75 days Average 20 days

Complications related to surgery Hoarseness of voice 2 Infection 1 Dysphagia 1 Loose fixation 2

Complications General Death 3 DVT 2 Bed Sores 5

Case Illustrations

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Case 3

Case 4

Case 5 

Case 6

Case 7

Case Illustration8.

Case 9

Summary & Conclusions  Anterior approach is better in our experience  Early surgical intervention improves out come  Delayed treatment is common in Oman  Reluctance in accepting surgical treatment

Suggestions  Early detection and emergency treatment in the periphery  Early transfer  Better facilities at receiving end  Rehabilitation services  Team work