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Comparative Study
. 2006 Feb;30(1):54-8.
doi: 10.1007/s00264-005-0016-4. Epub 2005 Oct 25.

Surgical treatment for injuries of the middle and lower cervical spine

Eiren Toh  1 , Takeshi Nomura, Masahiko Watanabe, Joji Mochida
Affiliations
Comparative Study

Surgical treatment for injuries of the middle and lower cervical spine

Eiren Toh et al. Int Orthop. 2006 Feb.

Abstract
in English, French

We reviewed the surgical treatment of 31 patients with burst fractures or teardrop dislocation fractures in the middle and lower cervical spine. Patients were treated with anterior instrumentation, posterior instrumentation, or a combination of both. Patients were evaluated radiographically and with the Frankel neurological outcomes grading scale. Anterior decompression and fusion restored the spinal canal diameter by approximately 60% whereas the posterior or combined approaches restored the canal diameter by only 6%. In addition, nine of 24 patients treated anteriorly gained improved neurological function whereas none of the patients treated posteriorly had neurological improvement. Based on the anatomical and neurological findings, the study demonstrates that anterior fusion is preferable to posterior fusion for the treatment of burst fractures and tear-drop dislocation fractures of the middle and lower cervical spine.

Nous avons revus le résultat du traitement chirurgical de 31 malades avec une fracture comminutive ou une fracture-luxation en flexion (tear drop) du rachis cervical moyen et inférieur. Les malades ont été traités avec une instrumentation antérieure, une instrumentation postérieure, ou une combinaison des deux. Les malades ont été évalués radiographiquement et avec le score neurologique de Frankel. La décompression-fusion antérieure a restauré le diamètre du canal vertébral approximativement dans 60% des cas, alors que les abords postérieurs ou combinés ont restauré le diamètre du canal dans seulement 6% des cas. De plus, 9 des 24 malades traités par voie antérieure ont vu leur fonction neurologique améliorée, alors qu’aucun des malades traités par voie postérieure n’avait d’amélioration neurologique. Basé sur les conclusions anatomiques et neurologiques, l’étude démontre que la fusion antérieure est préférable à la fusion postérieure pour le traitement des fractures comminutives et des fracture-luxations en flexion de la colonne vertébrale cervicale moyenne et inférieure.

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Figures

Fig. 1
Fig. 1
a In burst fractures, the percentage of spinal canal compromise was computed as 100×b/a b In teardrop fractures, the percentage of spinal canal compromise resulting from retrolisthesis was computed as 100×b/a
Fig. 2
Fig. 2
Improvement in motor function of patients by Zancolli’s classification a in the anterior burst (A-B) group, b in the anterior teardrop (A-TD) group, and c in the posterior teardrop (P-TD) group
Fig. 3
Fig. 3
The retropulsion of bone a at the vertebral body level in a burst fracture and b at the interbody level in a teardrop dislocation fracture
See this image and copyright information in PMC

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