Treatment of subaxial cervical spinal injuries

Academic Article

Abstract

  • In conclusion, closed reduction is successful for most subaxial cervical spinal fracture-dislocation injuries. Failure of closed reduction is more common with facet dislocation injuries. Similarly, treatment with external immobilization is frequently successful in the management of most subaxial cervical spinal injuries, although failure to maintain reduction is more frequent with facet dislocation injuries as well. Virtually all forms of external immobilization have been used in the treatment of subaxial cervical spinal injuries. More rigid orthoses (halo, Minerva) seem to have better success rates than less rigid orthoses (collars, traction only) for fracture-dislocation injuries after reduction has been accomplished. Treatment with traction and prolonged bedrest has been associated with increased morbidity and mortality. Both anterior and posterior cervical fusion procedures are successful in achieving spinal stability for most patients with subaxial cervical spinal injuries. Indications for surgical treatment offered in the literature include failure to achieve anatomic injury reduction (irreducible injury), persistent instability with failure to maintain reduction, ligamentous injury with facet instability, spinal kyphotic deformity more than 15 degrees, vertebral body fracture compression of 40% or more, vertebral subluxation of 20% or more, and irreducible spinal cord compression. Anterior fusion without plate fixation is associated with an increased likelihood of graft displacement and the development of late kyphosis, particularly in patients with distractive flexion injuries. Similarly, late displacement with kyphotic angulation is more common in patients treated for facet dislocation injuries with posterior fusion and wiring compared with those treated with posterior fusion and lateral mass plate or rod or interlaminar clamp fixation. Although patients with persistent or recurrent cervical spinal malalignment often achieve spinal stability with either external immobilization or surgical fusion with or without internal fixation, a higher proportion of these patients have residual cervical pain than similarly treated patients for whom anatomic spinal alignment is achieved and maintained.
  • Published In

  • Neurosurgery  Journal
  • Author List

  • Hadley MN
  • Volume

  • 50
  • Issue

  • 3 SUPPL.