Simple Posterior Approach Combined With Pedicle Screw Fixation For The Treatment Of Lower Cervical Fractures And Dislocations With Traumatic Disc Injuries

Objective:To explore and evaluate the feasibility, safety and clinical efficacy of using the simple posterior approach with cervical pedicle screw fixation technique for the treatment of lower cervical spine fractures and dislocations with traumatic disc injuries by retrospective analysis.Methods:Analyzed and summarized retrospectively the clinical data and follow-up data of12cases who suffered lower cervical fractures and dislocations with traumatic disc injuries and underwent cervical pedicle screw system fixation surgery from September2009to January2012.9cases were male and3females, aged from24to61years, average41years old; The mechanisms of injure to the lower cervical injury included seven fall injure, three traffic accidents injure, two heavy object crashes injure; All patients had various degrees of cord injury, and they were classified according to the American Spinal Cord Injury Association (ASIA) Impairment Scale:three cases were grade A, five grade B, two grade C, one grade D, one grade E. Three injuries were located at C4-5, five at C5-6, four at C6-7. Four cases had unilateral facet joint fracture-dislocation, eight cases bilateral facet joint fracture-dislocation.Preoperative magnetic resonance imaging (MRI) data were obtained for all patients. According to the standards set by Vaccaro and Grant, found disc injury in12cases which includes2with disc herniation(traumatic cervical disc herniation) and9with disruption. Three patients were treated by simple posterior pedicle screw fixation within4days after admitted to hospital, the remaining nine cases underwent surgery at7days later after admission, fixed range include1-2segments upper and lower the dislocation segments.Result:Reduction and fixation of the injured segment(s) were performed via a posterior approach in all12patients.64pedicle screws were inserted successfully in all patients on the postoperative radiographic and CT scans. Followed up for3-23months, average9months, there was no vertebral artery injury, spinal cord injury, or nerve root injury occurred during the operation in the current study. All patients with incomplete neurological deficits experienced improvement after operation according to the American Spinal Cord Injury Association (ASIA) Impairment Scale. No neurological recovery was demonstrated in the three patients with complete SCI and neurological deterioration was not observed immediately after surgery or during the course of the follow-up period.4cases grade B improved to grade C and the rest cases were complete recovery at final follow up. During the course of the follow up, solid bone union was achieved in all patients. There were no hardware failures, such as failure of implant components, screw loosening, or lucent zone formation around the pedicle screws. Postoperative MRI was obtained for all patients. MRI showed disappearance of the thecal sac and/or spinal cord compression after reduction in all cases.Conclusion:The cervical pedicle screw system allowed three-dimensional reduction of the injured cervical segment and reduction or reversal of a disc herniation at the same time, without neurological deterioration. The simple posterior approach with cervical pedicle screw fixation technique for the treatment of lower cervical spine fractures and dislocations with traumatic disc injuries is safe and effective.