Study design: Retrospective study of 9 patients who underwent operations as treatments of old distractive flexion injuries (DFI, Stage 2 and 3) of subaxial cervical spine.
Objective: Description of a novel operative sequence for reduction and stabilization of old DFI of subaxial cervical spine, and assessment of the clinical outcome.
Summary of background data: Subaxial cervical spine injuries are often missed on the primary trauma survey. However, there is a relative paucity of published clinical data regarding the treatment of old DFI (>or=3 weeks) of subaxial cervical spine. Our technique minimizes the total number of necessary procedures and differs in sequence from previously reported methods.
Methods: Between January 2001 and January 2004, 9 patients with old DFI (Stage 2 and 3) of subaxial cervical spine underwent operative treatments and were followed-up for at least 2 years. A posterior procedure was conducted first, comprised of soft tissue release, facetectomy and interspinous wiring. Subsequent anterior procedure included soft tissue release, discectomy, reduction, intervertebral grafting, and anterior plating. One functional spinal unit was fused in this group. Neck pain, neurologic status, and radiographs were recorded throughout the patient's course.
Results: Intraoperative anatomic reduction was achieved by this technique in all patients. Neck pain significantly remitted after the operation and neurologic function improved. All involved segments maintained the anatomic reduction until bony fusion was achieved, with the exception of one case of DFI (Stage 3) at C6-C7 level, who lost partial reduction but achieved fusion ultimately.
Conclusion: Using the posterior-anterior procedures, anatomic reduction was successfully achieved for old DFI of subaxial cervical spine, with decreased need to turn patients during operative interventions compared with previously reported techniques. Segmental stability was maintained till fusion, with the exception of one case of DFI at the C6-C7 level. Preliminary clinical outcomes were satisfying.