Surgical Treatment of Lower Cervical Fracture-Dislocation with Spinal Cord Injuries by Anterior Approach: 5-to 15-Year Follow-Up

BACKGROUND: Lower cervical fracture-dislocations frequently occur with spinal cord injuries. There is no clear consensus on best treatment option. Anterior approach surgery with direct decompression and reduction has become widely accepted. We assessed clinical outcomes of anterior approach surgery in a retrospective cohort study. METHODS: From January 2001 to January 2011, 312 patients with lower cervical spine fracture-dislocation with spinal cord injuries who were treated by the anterior approach were retrospectively analyzed. Of 312 patients, 218 (70%; 121 men and 97 women) met inclusion criteria. Clinical efficacy was evaluated using Odom's criteria and statistical analysis based on Cobb angle of kyphosis and Neck Disability Index and Japanese Orthopedic Association scores. Neurofunctional recovery of patients was assessed by the American Spinal Injury Association system. RESULTS: Average follow-up was 8.9 +/- 2.9 years (range, 5-15 years). Kyphosis angle and Neck Disability Index and Japanese Orthopaedic Association scores were significantly changed from preoperative values of 10.6 degrees +/- 8.9 degrees and 39.7 +/- 4.3 and 7.6 +/- 2.4 to last follow-up values of -5.2 degrees +/- 8.6 degrees and 10.8 +/- 4.6 and 15.6 +/- 1.2 (P < 0.05). Of patients, 197 (90.4%) had good to excellent outcomes, 14 (6.4%) had satisfactory outcomes, and 7 (3.2%) had poor outcomes. Varying degrees of neurologic function recovery were shown by 143 of the original 218 patients (65.6%) and 140 of 191 patients with incomplete paralysis (73.3%). CONCLUSIONS: For lower cervical fracture-dislocation with spinal cord injuries, satisfactory clinical outcomes can be obtained with an anterior approach. The anterior approach restored normal cervical spine structure and promoted functional recovery to achieve a good long-term curative effect.