1. Anterior Stabilization in Cervical Spine Fractures

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

3. Spinal cord injuries  Constitute 2-5 % of all blunt trauma  40-50 cases / million  40 % of cervical spine injuries have cord involvement  Cost factor

4. 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

5. Indications  Instability  Decompression  Stabilization Anterior posterior

6. 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

7. 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

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

9. 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

10. Khoula experience

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

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

13. Surgical Procedure

14. Anatomy

19. Types of plates

20. A retrospective study 32 cases

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

22. Cause of injury RTA25 Domestic Fall2 Fall from tree5

23. DislocationC3-C4 2 C4-C5 7 C5-C6 7 DISLOCATIONC 6-7 3 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

24. 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

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

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

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

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

29. Complications General Death 3 DVT 2 Bed Sores 5

30. Case Illustrations

32. Case2

33. Case 3

34. Case 4

35. Case 5 

36. Case 6

37. Case 7

38. Case Illustration8.

39. Case 9

40. 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

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