The Imageological Sification And Treatment Choice Of The Sagittal Fracture Of Cervical Spine

Objective:According to the appearance of the sagittal fracture of cervical spine on CT imaging,a new classification is going to be proposed,and the treatment choice of the sagittal fracture of cervical spine is going to be discussed.Methods:From 305 cases of cervical spine fracture who were treated in Nanfang Hospital,Southern Medical University,during June 2002 to June 2019,cases of the sagittal fracture of cervical spine were screened out According to the morphology of the sagittal fracture of cervical spine on CT,the imageological classification of the sagittal fracture of cervical spine had been done.General and clinical data including age,gender,injury reasons,sagittal fracture segments,combined injury and treatment was been recorded and the system of American spinal injury association(ASIA)grade was been applied to evaluate neurological function.Multiple ordered logistic regression was used to analyze the correlation between classification of the sagittal fracture of cervical spine and grade of ASIA.Methods of treatment of the sagittal fracture of cervical spine were retrospectively analyzed to explore treatment choices of the sagittal fracture of cervical spine.Result:In this study,a total of 17 cases of the sagittal fracture of cervical spine were included,accounting for 5.57%of cervical spine fractures in the same period.Fourteen patients were male and three patients were female with an average age of 38 years old(range from 16 to 55).Among them,9 patients were injured by falls from height,6 patients were injured by traffic accidents,1 patient was injured by heavy objects hited and 1 patient was injured by falls from ground.Sagittal fracture segments were mainly distributed in C5 and C6.According to the morphology of the sagittal fracture of cervical spine on CT,the specific classification is as follows:Type Ⅰ(pure vertebral fracture type):pure vertebral sagittal fracture without dislocation,and is not associated with vertebral arch(vertebral pedicle or lamina)fractures.4 cases were included in this group with accounting for 23.53%(4/17).TypeⅡ(unilateral vertebral arch fracture type):vertebral sagittal fracture,without dislocation,unilateral vertebral arch(vertebral pedicle and lamina)fractures.3 cases were included in this group with accounting for 17.65%(3/17).Type Ⅲ(bilateral vertebral arch fracture type):vertebral sagittal fracture,without dislocation,consolidated bilateral vertebral arch(vertebral pedicle and lamina)fractures.1 cases were included in this group with accounting for 5.88%(1/17).Type Ⅳ(fracture with dislocation):vertebral sagittal fracture,cervical dislocation,with or without associated with vertebral arch(vertebral pedicle and lamina)fractures.9 cases were included in this group with accounting for 52.94%(9/17).Multiple ordered logistic regression analysis results showed that the Ⅰ compare with Ⅳ,ASIA grade is 0.023 times more likely to at least one level higher(P=0.018),and Ⅱ compare with Ⅳ,ASIA grade is 0.01 times more likely to at least one level higher(P=0.009).One patient with type Ⅳ fracture died of respiratory failure four days after admission.Three patients were treated with Halo-Vest external fixation,including 2 type Ⅰ fractures and Ⅰ type Ⅱfractures.Two patients with type Ⅰ fracture and type Ⅱ fracture underwent anterior surgery.One patient with type Ⅲ fracture underwent posterior surgery.Seven patients with type Ⅳfractures underwent anterior surgery,and 1 patient with type Ⅳ underwent anterior combined posterior surgery.Compared with the ASIA grade before treatment,the ASIA grade of 3 patients(18.7%)had improved on 1 month after treatment.Conclusion:As a special type of cervical spine fracture,the sagittal fracture of cervical spine is relatively rare.The sagittal fractures of cervical spine generally were caused by high-energy violent injuries such as traffic accidents and fall from high place and generally were accompanied by severe spinal cord injury.The classification of the sagittal fracture of cervical spine based on CT imaging which was proposed by us is simple and practical,and is able to reflect the severity of injury,and also has certain guiding significance for treatment choices.