Session II - Spine

Friday, October 17, 1997 Session II, 11:56 a.m.

Rotationally Unstable Fractures of the Cervical Spine

Robert Lifeso, MD, Michael Colucci, MD, Christopher Hamill, MD

Erie County Medical Center, Buffalo, New York, USA

Purpose: To compare the efficacy of halo vest immobilization, posterior cervical plating and anterior cervical plating in lateral mass fracture of the cervical spine [compression extension stage 1].

Methodology: Between 1987 and 1992, thirty-two patients presented to a Level I spinal cord injury unit with compression extension stage 1 fractures of the cervical spine. In this retrospective study, sixteen patients were initially treated either with halo vest immobilization or rigid cervical orthosis. Eleven patients underwent posterior cervical plating and the five remaining underwent posterior midline wiring.

This retrospective study led to a prospective study and from 1993 through December 1995 twenty further patients presenting with this fracture pattern underwent an immediate anterior cervical discectomy, iliac crest bone grafting and plating.

Results: Thirty-five percent of the patients treated with a halo vest had an unsuccessful outcome related either to failure to maintain reduction, persistent radiculopathy or cord impairment. The patients with a rigid cervical orthosis had a uniformly poor result related to inability to control rotational forces with an axial distractive phenomena. Posterior cervical plating was initially successful in all patients but 44% later went on to develop increasing kyphosis related to disc space collapse.

The anterior cervical discectomy and plating group all went on to rapid resolution of neurological deficit and all at one year follow up have shown a solid fusion in an anatomic position.

Conclusion: Compression extension stage 1 injuries to the cervical spine account for 10% of all cervical injuries seen in a Level 1 spinal cord injury unit. Techniques to control this rotational listhetic fracture by axial traction, i.e., halo vest or rigid orthoses, have been unsuccessful; posterior plating techniques have been unsuccessful because of late disc space collapse and we would now recommend an anterior cervical discectomy and fusion.