An Analysis Of Surgical Treatment For Lower Cervical Fracture-dislocation Combined Spinal Cord Injury

Objective: To discuss the relations of lower cervical spine damage type, operative approach, surgery opportunity and curative effect.Methods: From Jan 2003 to Jan 2008, according to the types of injury and the parts of spinal cord compression, 68 patients of lower cervical fracture-dislocation with spinal cord injury chose corresponding surgical treatment : to the vertebral body, intervertebral disc and so on suffer damage, patients of spinal cord compression from the front undertook anterior surgical fixation (A group), a total of 38 cases; patients of fractures of the lamina, the rear ligament injury, hematoma and so on spinal cord compression from the rear recieved posterior surgical fixation (B group), altogether 17 cases; patients of both front and rear side of spinal cord compression underwent anterior-posterior surgical fixation (C group)in one stage, altogether 13 cases, including cases of facet locking traction failed to reset. Patients of injury to operation time≤3 d were 31 cases; patients of injury to operation time > 3 d were 31 cases.Spinal function was evaluated by JOA (Japanese Orthopaedic Association) guidance and ASIA(American Spinal Injury Association)grades at hospital admission and at the follow-up time of 12th month, neurological improvement was expressed by the recovery rate.Results: The patients were followed up from 12 months to 48 months (average 21.4 months). Cervical spine X-ray film prompted a review of all patients with cervical spine fracture and dislocation was reset, the cervical vertebrae sequence and physiological curvature were restored. The bones were fused in 6 months. No complications occurred in the present study, such as loosening, displacement or breakage of the plate and screw. Neck and cervicobrachial pain had been cured or greatly improved. Cervical spinal cord injury improved to different degrees according to the ASIA evaluation system. JOA scores: The statistical difference among group A, B and C didn't exist before surgery (P>0.10);a marked improvement was made at the follow-up time of 12th month each group (P<0.01); there was no statistical difference among three groups in the recovery rate (P>0.10). Injury to operation time≤3 d and> 3 d, the preoperative score was no statistical difference(7.6±3.2, 7.8±3.6, P>0.10); after 12 months of review, the recovery rate of injury to operation time≤3 d were superior to that of > 3 d (78.6±23.9, 61.5±27.8, P<0.01).Conclusions:①Anterior, posterior or anterior-posterior surgical fixation can all get an ideal anatomic reduction and improve function of spinal cord for lower cervical fracture-dislocation combined spinal cord injury. It is important to select a suitable surgical treatment according to the types of lower cervical injury and the parts of spinal cord compression.②The surgery treatment time is more early more advantageous in damaged spinal cord's function restoration.