Concept for direct reduction of large-sized cervical tear-drop fractures through a single anterior approach with follow up of five cases

Abstract

Introduction: Unstable large sized tear-drop fractures of the cervical spine (LSTDF) are difficult fractures to operate and there is a lack of standard in treatment. This study introduces an innovative technique for direct tear-drop fragment osteosynthesis with anterior cervical discectomy and fusion (TDFO-ACDF) and retrospectively analyzes clinical and radiological outcomes in five patients.

Patients and methods: Through a standardized anterior approach, the tear-drop fragment was reduced anatomically, the lower endplate restored and stabilized with lag-screws. Additionally, in four of five cases an anterior cervical discectomy and fusion (ACDF) using iliac crest bone graft was performed in combination with a VECTRA plate (DePuy Synthes, Zuchwil, Switzerland). X-ray check-up and functional outcome (neck disability index, NDI) was assessed during regular outpatient visits for at least two years postoperative.

Results: From 2013 until 2021 we operated five patients with the above-mentioned injury. All patients were operated the day after the accident and were hospitalized for 4 to 7 days. None of them had any neurological failures and all of them showed full clinical and radiological recovery without any clinical impairments. Median NDI was 2% ranging from 0 to 4% after a median follow up of 39 months (range 29 to 119 months).

Conclusion: The presented concept for treating large-sized tear-drop fractures of the cervical spine is safe. Utilizing a standard anterior approach with fundamental fracture management principles, this method enables direct bone healing and provides excellent postoperative results.

Keywords: Anterior discectomy and cervical fusion; Fracture fixation, internal; Spinal fusion; Spine, surgery; Surgical procedures, operative; Teardrop fracture.