Anterior interbody fusion for cervical fracture-dislocations
Cervical fracture-dislocation continue to be a difficult therapeutic problem. It gives more prolonged and complexing neurological deficits and complications than any other injuries.
Since the introduction of skull tongs for skeletal traction by Crutchfield in 1993, very little had been added to treat these cases until the works of Daereymaker, Smith and Robinson, and Cloward who introduced the value of anterior approach for carvical fracture-dislocations around 1955.
The therapeutic efforts at present are confined to the preservation of life and of any residual functions which might later be more fully developed during recovery and rehabillitation.
The author has reviewed 51 cases of cervical fracture-dislocations treated at Yonsei University, Severance Hospital and Hanyang University, Medical Center from 1964 to 1972; 23 cases were treated by sample traction, 27 cases by anterior interbody fusion and one case by posterior internal splint using resin and wiring.
1. Early anterior approach to the cervical fracture-dislocation offers a unique opportunity for the surgeon to directly visualize and treat the lesion producing spinal cord compression, wheather it be a herniated disc or bony fragments. The spinal instability may br corrected by a vertebral fusion, and prolonged immobilitation is instituted immediately following surgery.
2. Myelography and Queckenstedt's test is contraindicated except in the few limited cases to find disc ruptures around the lesion.
3. Acute disc rupture was found in almost all the surgical cases. In some cases, disc removal was inevitable after conservative therapy. And interbody fusion give the best prognosis.
4. For the reduction of new locked facets, posterior approach is easier and safer than anterior approach. But in the case of old locked facets, all scar tissue should be excised before posterior approach and anterior interbody fusion.
5. Anterior angulation in the surgical cases were resulted from compression of vertebral body and distruption of posterior spinal ligaments, and it can be prevented by postoperative traction of two to three weeks duration.