The Comparative Analysis Of Two Surgical Approaches For The Treatment Of Subaxial Cervical Spine Fracture-dislocation

Background and Objective: With the development of society economy,lower cervical spine injuries caused by violence such as traffic,falling from heights and bruising have become more and more common.There is an epidemiological investigation from 488,262 patients in the United States conducted by Peter G and collages[1].The results showed that the incidence of cervical fractures in 2005 was 4.1%,2013 reached 5.4%.Kocis [2] and Zhou [3] believe that cervical fracture and dislocation is a serious injury for the lower cervical spine,which often results in extreme instability of the cervical spine,disruption of cervical curvature,anti-bow or angulation,and changes in the volume of the spinal canal which often combining different degrees of cervical spinal cord injury.Cervical fractures can lead to severe dysfunction,high treatment costs,and reduced life expectancy.Lower cervical injury accounts for 65% of all cervical injuries [4].Local pain was evident in the neck and the neck was compulsively fixed and leaned forward slightly.The general manifestations were rapid breathing and slowness.Severe patients had varying degrees of quadriplegia,lower limb paralysis or partial paralysis.resulting in a poor prognosis with high mortality and morbidity [5,6].Due to the different sites and degrees of injury,there is no uniform standard for surgical methods [7-10].The purpose of this study was to evaluate the amount of bleeding,operative time,cost and treatment effect of one-stage posterior decompression combined with anterior decompression internal fixation and one-stage posterior decompression combined anterior fusion and fusion.The difference between the two types of surgical procedures provides a reference for the selection of surgical procedures for patients with clinical fractures and dislocations of the lower cervical spine.Method: We retrospectively reviewed patients who are traumatic cervical facet dislocation during 2012 to 2016,a total of 14 consecutive cases received surgical treatment with one-stage combined posterior laminectomy decompression with anterior cervical plate internal fixation;17 consecutive cases are treated with one-stage combined anterior and posterior fixation/fusion.The approach-related effects were evaluated by comparaing surgical time and blood loss.Statistical comparison of 1 week postoperatively,3 months postoperatively,1 year postoperatively and the last follow-up results of the Japanese Orthopedic Association(JOA)score were conduced for the asessment of recovery rate.The Frankel spinal cord injury grades were evaluated before and at the end of the postoperative follow-up to compare the treatment effects of the two groups.X-ray films were reviewed and the stability of the injured segments and the improvement of bone graft fusion rate were compared between the two groups.Results: In group A,the intraoperative blood loss was(290.01±102.20)ml,and the operation time was(4.12±1.08)h.In group B,the intraoperative blood loss was(494.16±262.21)ml,and the operation time was(4.95±1.37)h.Comparing with Group B,there is a less amount of intraoperative blood loss a shorter operation time in Group A.The difference was statistically significant(P<0.05).The improvement rates of JOA at 1 week postoperation,3 months postoperation,1 year postoperation and last follow-up in group A were(0.51±0.08)%,(0.66 0.11)%,(0.67±0.11)% and(0.76±0.12).In group B,the JOA improvement rate at 1 week postoperation,3 months postoperation,1 year postoperation and last follow-up was(0.49±0.07)%,(0.63±0.12)%,(0.70±0.12)% and(0.80±0.10)%.There was no significant difference in JOA improvement rate at 1 week postoperatively,3 months postoperatively,1 year postoperatively and last follow-up between the two groups(P>0.05).There was no recovery in spinal cord function in 1 patient with complete injury in both groups,and spinal cord function was not improved in 3 patients with incomplete spinal cord injury in each group.The Frankel score was increased by 1-2 grade of the other patients.In the two groups at the last follow-up,the DR segment showed a good sequence of injury and no bone graft fusion occurred.Conclusion: One-stage posterior decompression combined with anterior fixation fusion and one-stage posterior extended decompression fixation combined with anterior fixation fusion for the treatment of fracture dislocation after traumatic lower cervical spine can completely relieve oppression from the anterior spinal canal and spinal canal,recovering spinal sequence and maintaining the stability of the injury segment.There was no significant difference in treatment effect of the two methods.However,compared with the first-stage posterior decompression fixation combined with anterior fusion and fusion,the first-stage posterior decompression combined with anterior fixation fusion has the advantages of short operative time,less bleeding and lower treatment costs.