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Is only Anterior Stabilization Enough in Three-Column Injury of Subaxial Cervical Spine? – A Long-Term Retrospective Analysis of 78 Patients
STUDY DESIGN: This was a retrospective study. PURPOSE: The purpose was to retrospectively evaluate long-term outcome of anterior stabilization in three-column injury of the subaxial cervical spine. OVERVIEW OF LITERATURE: Literature shows varied results regarding the approach to be chosen. Most stud...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Wolters Kluwer - Medknow
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8477831/ https://www.ncbi.nlm.nih.gov/pubmed/34660362 http://dx.doi.org/10.4103/ajns.AJNS_518_20 |
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author | Srivastava, Sudhir K Gaddikeri, Manojkumar Raj, Aditya Bhosale, Sunil Marathe, Nandan Naseem, Atif |
author_facet | Srivastava, Sudhir K Gaddikeri, Manojkumar Raj, Aditya Bhosale, Sunil Marathe, Nandan Naseem, Atif |
author_sort | Srivastava, Sudhir K |
collection | PubMed |
description | STUDY DESIGN: This was a retrospective study. PURPOSE: The purpose was to retrospectively evaluate long-term outcome of anterior stabilization in three-column injury of the subaxial cervical spine. OVERVIEW OF LITERATURE: Literature shows varied results regarding the approach to be chosen. Most studies prefer a combined approach since biomechanically forms more stable construct. The isolated posterior approach is preferred by many as it is easy to reduce and fix three-column injuries. There are very few studies which show the isolated anterior approach to be better than the other two. MATERIALS AND METHODS: Seventy-eight patients of three-column injury operated by anterior approach with follow-up of atleast 2 years were included and retrospectively analyzed. Clinical data included age, sex, time to surgery, methods of reduction, postoperative mobilization, and neurological evaluation using the ASIA scale. Radiological data included pre- and postreduction X-ray, computed tomography, and magnetic resonance imaging (MRI). X-rays taken post-operatively at 1,3, 6 months, 1yr and 2yrs. Variables like fracture type (AO Classification), overall alignment, localized kyphosis, time for fusion and grade of fusion mass were noted. RESULTS: Of 78 patients, 61 had bifacetal dislocation and 17 unifacetal. The most common site was C5-6, followed by C3-4 and C6-7. The mean patient age was 35.98 years with 60 males and 18 females. The mean time to surgery was 4.4 days. Forty dislocations were reduced by closed method and 38 by open anterior approach. Fifty-six percent of patients had traumatic disc injury on MRI. All are managed by single-level anterior cervical discectomy and fusion with iliac crest autograft for fusion. The mean preoperative lordosis: 4.44° (range −13.4° to 25°) and mean postoperative lordosis: 28.57° (P < 0.0001) mean loss of alignment: 2.59° by 2 years, 100% fusion with mean time – 22.82 weeks, neurological recovery in 34.6% with atleast one grade improvement in ASIA scale. No neurological worsening or need for revision surgery was observed. CONCLUSION: The goal of surgery in cervical injury is bony stabilization and fusion using a least morbid approach and one with good long-term outcome. Above study concludes that only anterior stabilization after reduction of three-column injury would suffice with good long-term outcome, thereby obviating need for global fusion. |
format | Online Article Text |
id | pubmed-8477831 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Wolters Kluwer - Medknow |
record_format | MEDLINE/PubMed |
spelling | pubmed-84778312021-10-14 Is only Anterior Stabilization Enough in Three-Column Injury of Subaxial Cervical Spine? – A Long-Term Retrospective Analysis of 78 Patients Srivastava, Sudhir K Gaddikeri, Manojkumar Raj, Aditya Bhosale, Sunil Marathe, Nandan Naseem, Atif Asian J Neurosurg Original Article STUDY DESIGN: This was a retrospective study. PURPOSE: The purpose was to retrospectively evaluate long-term outcome of anterior stabilization in three-column injury of the subaxial cervical spine. OVERVIEW OF LITERATURE: Literature shows varied results regarding the approach to be chosen. Most studies prefer a combined approach since biomechanically forms more stable construct. The isolated posterior approach is preferred by many as it is easy to reduce and fix three-column injuries. There are very few studies which show the isolated anterior approach to be better than the other two. MATERIALS AND METHODS: Seventy-eight patients of three-column injury operated by anterior approach with follow-up of atleast 2 years were included and retrospectively analyzed. Clinical data included age, sex, time to surgery, methods of reduction, postoperative mobilization, and neurological evaluation using the ASIA scale. Radiological data included pre- and postreduction X-ray, computed tomography, and magnetic resonance imaging (MRI). X-rays taken post-operatively at 1,3, 6 months, 1yr and 2yrs. Variables like fracture type (AO Classification), overall alignment, localized kyphosis, time for fusion and grade of fusion mass were noted. RESULTS: Of 78 patients, 61 had bifacetal dislocation and 17 unifacetal. The most common site was C5-6, followed by C3-4 and C6-7. The mean patient age was 35.98 years with 60 males and 18 females. The mean time to surgery was 4.4 days. Forty dislocations were reduced by closed method and 38 by open anterior approach. Fifty-six percent of patients had traumatic disc injury on MRI. All are managed by single-level anterior cervical discectomy and fusion with iliac crest autograft for fusion. The mean preoperative lordosis: 4.44° (range −13.4° to 25°) and mean postoperative lordosis: 28.57° (P < 0.0001) mean loss of alignment: 2.59° by 2 years, 100% fusion with mean time – 22.82 weeks, neurological recovery in 34.6% with atleast one grade improvement in ASIA scale. No neurological worsening or need for revision surgery was observed. CONCLUSION: The goal of surgery in cervical injury is bony stabilization and fusion using a least morbid approach and one with good long-term outcome. Above study concludes that only anterior stabilization after reduction of three-column injury would suffice with good long-term outcome, thereby obviating need for global fusion. Wolters Kluwer - Medknow 2021-09-14 /pmc/articles/PMC8477831/ /pubmed/34660362 http://dx.doi.org/10.4103/ajns.AJNS_518_20 Text en Copyright: © 2021 Asian Journal of Neurosurgery https://creativecommons.org/licenses/by-nc-sa/4.0/This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms. |
spellingShingle | Original Article Srivastava, Sudhir K Gaddikeri, Manojkumar Raj, Aditya Bhosale, Sunil Marathe, Nandan Naseem, Atif Is only Anterior Stabilization Enough in Three-Column Injury of Subaxial Cervical Spine? – A Long-Term Retrospective Analysis of 78 Patients |
title | Is only Anterior Stabilization Enough in Three-Column Injury of Subaxial Cervical Spine? – A Long-Term Retrospective Analysis of 78 Patients |
title_full | Is only Anterior Stabilization Enough in Three-Column Injury of Subaxial Cervical Spine? – A Long-Term Retrospective Analysis of 78 Patients |
title_fullStr | Is only Anterior Stabilization Enough in Three-Column Injury of Subaxial Cervical Spine? – A Long-Term Retrospective Analysis of 78 Patients |
title_full_unstemmed | Is only Anterior Stabilization Enough in Three-Column Injury of Subaxial Cervical Spine? – A Long-Term Retrospective Analysis of 78 Patients |
title_short | Is only Anterior Stabilization Enough in Three-Column Injury of Subaxial Cervical Spine? – A Long-Term Retrospective Analysis of 78 Patients |
title_sort | is only anterior stabilization enough in three-column injury of subaxial cervical spine? – a long-term retrospective analysis of 78 patients |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8477831/ https://www.ncbi.nlm.nih.gov/pubmed/34660362 http://dx.doi.org/10.4103/ajns.AJNS_518_20 |
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