The Outcome of Subaxial Cervical Injury in Adult Patients Managed Surgically Through an Anterior Approach

  • Aurangzeb Kalhoro Jinnah Medical and Dental College, Karachi, Pakistan
  • Abdul Samad Panezai Sandeman civil hospital, Quetta
  • Sher Hassan Sandeman civil hospital, Quetta,
  • Farrukh Javeed Jinnah Postgraduate Medical Centre, Karachi
  • Lal Rehman Jinnah Postgraduate Medical Centre, Karachi,
Keywords: Subaxial cervical injury, anterior approach

Abstract

Objectives:  We determined the Outcome of subaxial cervical injury management in adults through anterior approach open reduction and fixation injury < 72 hours.

Material and Methods:  A total of 71 patients declared to have a recent chronicle of traumatic cervical spine injury with a conventional diagnosis of subaxial injury by Magnetic Resonance Imaging (MRI) and X-Ray anteroposterior and lateral views. ASIA Impairment Scale was used for assessment and was done at the time of admission and after six months.

Results: Mean age of the patients in our study was 38.54 ± 5.47 years. According to American Spinal Injury Association (ASIA) scale, improvement by two grades was seen in 18 cases and improvement by one – grade was observed in 48 cases. Mortality was seen in 5 cases, where 2 deaths were related to associated injury, one related to a complication of surgery and other 2 died due to aspiration complications. Out of 66 cases, the outcome was good in 49 (74.29%) and fair in 17 (25.76%).

Conclusion:  The study results revealed that Anterior Cervical Discectomy and Fusion (ACDF) is considered to be a better treatment choice for better anatomical stabilization of the spine with early reduction.

Keywords:  Subaxial cervical injury, anterior approach, ASIA (American Spinal Injury Association) scoring.

References

1. Casper DS, McKenzie J, Schroeder GD. Controversial cervical spine fractures: Classification and treatment. In Seminars in Spine Surgery, 2017; 29 (1): 41-49. WB Saunders.
2. Dhakal GR, Bhandari R, Dhungana S, Poudel S, Gurung G, Kawaguchi Y, Riew KD. Review of Subaxial Cervical Spine Injuries Presenting to a Tertiary-Level Hospital in Nepal: Challenges in Surgical Management in a Third World Scenario. Global Spine Journal, 2019; 9 (7): 713-6.
3. Al-Samouly HM, Taha AM. Comparative Study of Surgical Approaches for Distractive Flexion Injuries of Sub-Axial Cervical Spine. Open Journal of Modern Neurosurgery, 2018; 8 (3): 342-51.
4. Jiang X, Yao Y, Yu M, Cao Y, Yang H. Surgical treatment for subaxial cervical facet dislocations with incomplete or without neurological deficit: a prospective study of 52 cases. Medical science monitor: international medical journal of experimental and clinical research, 2017; 23: 732.
5. Ding C, Wu TK, Gong Q, Li T, Ma LT, Wang BY, Deng YX, Liu H. Anterior release and nonstructural bone grafting and posterior fixation for old lower cervical dislocations with locked facets. Medicine (Baltimore), 2017 Nov; 96 (46): e8809.
Doi: 10.1097/MD.0000000000008809.
6. Mascarenhas D, Dreizin D, Bodanapally UK, Stein DM. Parsing the utility of CT and MRI in the subaxial cervical spine injury classification (SLIC) system: is CT SLIC enough? American Journal of Roentgenology, 2016; 206 (6): 1292-7.
7. Yue JK, Winkler EA, Rick JW, Deng H, Partow CP, Upadhyayula PS, Birk HS, Chan AK, Dhall SS. Update on critical care for acute spinal cord injury in the setting of polytrauma. Neurosurgical Focus, 2017; 43 (5): E19.
8. Joaquim AF, Rodrigues SA, DA Silva FS, DA Silva OT, Ghizoni E, Tedeschi H, Schroeder GD, Vaccaro AR, Patel AA. Is There an Association With Spino-Pelvic Relationships and Clinical Outcome of Type A Thoracic and Lumbar Fractures Treated Non-Surgically? Int J Spine Surg. 2018 Aug. 15; 12 (3): 371-376. Doi: 10.14444/5043.
9. Fariña MM, de la Barrera SS, Marqués AM, Velasco MF, Vázquez RG. Update on traumatic acute spinal cord injury. Part 2. Medicina Intensiva (English Edition). 2017; 41 (5): 306-15.
10. Du JP, Fan Y, Zhang JN, Liu JJ, Meng YB, Hao DJ. Early versus delayed decompression for traumatic cervical spinal cord injury: application of the AO Spine subaxial cervical spinal injury classification system to guide surgical timing. European Spine Journal, 2019; 28 (8): 1855-63.
11. Quarrington RD, Jones CF, Tcherveniakov P, Clark JM, Sandler SJ, Lee YC, Torabiardakani S, Costi JJ, Freeman BJ. Traumatic subaxial cervical facet subluxation and dislocation: epidemiology, radiographic analyses, and risk factors for spinal
cord injury. The Spine Journal, 2018; 18 (3): 387-98.
12. Izzo R, Popolizio T, Balzano RF, Pennelli AM, Simeone A, Muto M. Imaging of cervical spine traumas. Eur J Radiol. 2019; 117: 75-88.
Doi: 10.1016/j.ejrad.2019.05.007.
13. Joaquim AF, Ghizoni E, Tedeschi H, Yacoub AR, Brodke DS, Vaccaro AR, Patel AA. Upper cervical injuries: clinical results using a new treatment algorithm. Journal of Craniovertebral Junction & Spine, 2015; 6 (1): 16.
14. Zaveri G, Das G. Management of sub-axial cervical spine injuries. Indian Journal of Orthopedics, 2017; 51 (6): 633.
15. Fredø HL, Rizvi SA, Rezai M, Rønning P, Lied B, Helseth E. Complications and long-term outcomes after open surgery for traumatic subaxial cervical spine fractures: a consecutive series of 303 patients. BMC Surgery, 2016; 16 (1): 56.
16. Han MS, Lee GJ, Kim JH, Lee SK, Moon BJ, Lee JK. Outcomes of Anterior Cervical Fusion Using Polyetheretherketone Cage with Demineralized Bone Matrix and Plate for Management of Subaxial Cervical Spine Injuries. Korean Journal of Neurotrauma, 2018; 14 (2): 123-8.
17. Anissipour AK, Agel J, Baron M, Magnusson E, Bellabarba C, Bransford RJ. Traumatic cervical unilateral and bilateral facet dislocations treated with anterior cervical discectomy and fusion has a low failure rate. Global Spine Journal. 2017; 7 (2): 110-5.
18. Lozano CP, Chen KA, Marks JA, Jenoff JS, Cohen MJ, Weinstein MS. Safety of early tracheostomy in trauma patients after anterior cervical fusion. Journal of Trauma and Acute Care Surgery, 2018 Oct. 1; 85 (4): 741-6.
19. Chen KA, Marks JA, Jenoff JS, Cohen MJ, Weinstein MS. Safety of early tracheostomy in trauma patients after anterior cervical fusion. Journal of Trauma and Acute Care Surgery, 2018; 85 (4): 741-6.
Published
2021-01-01
Section
Original Article