Abstract
Long-term pain problems and residual restricted mobility were evaluated for patients sustaining acute distractive flexion injuries to the cervical spine. To assess which of two alternative surgical approaches gives better long-term outcomes, 58 patients were studied, 29 in each group. The results of posterior wire stabilization without fusion according to Brandt were contrasted with those of the Cloward technique. We found significantly more late pain problems and restricted neck mobility in the group treated with wiring without fusion than in those managed with anterior fusion. We conclude that this continuing pain may be due to residual mobility in the damaged degenerated non-fused motion segment, and that the difference between the two groups may reflect the difference in the quality and rate of fusion achieved by the two surgical approaches.
Key words: Cervical spine Trauma, Fusion, Stabilization
Full Text
The Full Text of this article is available as a PDF (802.9 KB).
References
- 1.Allen BL, Ferguson RL, Lehmann TR, O'Brian RP. A mechanistic classification of closed indirect fractures and dislocations of the lower cervical spine. Spine. 1982;1:1–27. doi: 10.1097/00007632-198200710-00001. [DOI] [PubMed] [Google Scholar]
- 2.Benzel EC, Kesterson L. Posterior cervical interspinous wiring and fusion for mid to low cervical spinal injuries. J Neurosurg. 1989;70:893–899. doi: 10.3171/jns.1989.70.6.0893. [DOI] [PubMed] [Google Scholar]
- 3.Brandt L, Feldborg Nielsen C, Saveland H, Wingstrand H. A simple techniqe of posterior wiring in traumatic instability of the mid to lower cervical spine. J Neurosurg. 1990;73:798–800. doi: 10.3171/jns.1990.73.5.0798. [DOI] [PubMed] [Google Scholar]
- 4.Capen DA, Garland DE, Waters RL. Surgical stabilization of the cervical spine. A comparative analysis of anterior and posterior fusions. Clin Orthop. 1985;196:229–236. [PubMed] [Google Scholar]
- 5.Carlsson AM. Assessment of chronic pain. Aspect of the use and the reliability and validity of visual analogue scale. Pain. 1983;16:87–94. doi: 10.1016/0304-3959(83)90088-X. [DOI] [PubMed] [Google Scholar]
- 6.Cloward RB. Treatment of acute fractures dislocations of the cervical spine by vertebral body fusion. A report of eleven cases. J Neurosurg. 1961;18:201–209. doi: 10.3171/jns.1961.18.2.0201. [DOI] [PubMed] [Google Scholar]
- 7.Feldborg Nielsen C, Annertz M, Persson L, Wingstrand H, Säveland H, Brandt L. Posterior wiring without bony fusion in traumatic distractive flexion injuries of the mid to lower cervical spine. Spine. 1991;14:467–472. doi: 10.1097/00007632-199104000-00015. [DOI] [PubMed] [Google Scholar]
- 8.Kahanovitz N, Arnocyzky SP, Levine DB. The effects of internal fixation on the cartilage of the unfused canine facet joint cartilage. Spine. 1984;9:268–272. doi: 10.1097/00007632-198404000-00008. [DOI] [PubMed] [Google Scholar]
- 9.Kahanovitz N, Bullough P, Jacobs PR. the effect of internal fixation without arthrodesis on human facet joint cartilage. Clin Orthop. 1984;189:204–208. [PubMed] [Google Scholar]
- 10.McLaurin RL, Vernal R, Salmon JH. Treatment of fractures of the atlas and axis by wiring without fusion. J Neurosurg. 1972;36:773–780. doi: 10.3171/jns.1972.36.6.0773. [DOI] [PubMed] [Google Scholar]
- 11.Rogers WA. Fractures and dislocations of the cervical spine. J Bone Joint Surg. 1957;89A:341–376. [PubMed] [Google Scholar]
- 12.Stauffer ES. Management of spine fractures C2-C7. Orthop Clin North Am. 1986;17:45–53. [PubMed] [Google Scholar]
- 13.Sutterlin CE, McAfee PC, Warden KE. A biomecharnical evaluation of cervical spinal stabilization methods in a bovine model. Static and cyclic loading. Spine. 1988;13:795–802. doi: 10.1097/00007632-198807000-00015. [DOI] [PubMed] [Google Scholar]
