[Traumatic dislocations/dislocation fractures of the cervical spine. Neurosurgical experiences in 42 surgical patients]

Abstract

Neurosurgical results in 42 patients operated on for cervical spine dislocations or fracture-dislocations are described. The study shows that repositioning with the Crutchfield extension is almost always successful. Imbricated fractures must occasionally be repositioned surgically (2 cases). A strikingly large proportion of patients (50%) in whom decompression was carried out ventrally were found to be suffering from traumatic disc hernia in the lower cervical spine. This was often accompanied by laceration of the posterior longitudinal ligament. Operative stabilization of unstable fractures, especially pseudarthrosis, of the odontoid process was performed in the main by dorsal immobilization (blocking) at C1/C2 (pelvic bone chips/wiring), whereby the residual rotational limitation was only of moderate degree and well tolerated subjectively. Two patients in whom stabilization was achieved in this way developed secondary ossification of the old pseudarthrosis of the odontoid process. In 2 cases the operation was carried out by the transbuccal route, again with the use of pelvic bone chips. Operative stabilization below C2 was performed 15 times using the ventral approach only, namely 13 times by Cloward's method and twice by Caspar's method. A combined ventrodorsal approach was used a total of 13 times in patients with severely damaged dorsal ligaments; here we made use ventrally of autologous pelvic bone chips, dorsally of wire osteosynthesis. The results were in the main good in respect of repositioning, uniformly good in respect of stability. In the great majority of cases with medullary or radiculomedullary deficits, the operation resulted in complete healing or at least an improvement, namely in 75% of patients with lesions of the odontoid process and in 81% of those with lesions below C2. In the second part of the study, the advantages and disadvantages of the various methods are set out and discussed in the light of recent advances and in particular of operative experience with tumours in the region of the cervical spine.