[Selection of surgical treatment of lower cervical dislocation].

OBJECTIVE

To discuss the selection of anterior or posterior or a combination of anterior and posterior surgical treatment of lower cervical dislocation.

METHODS

A retrospectively study was performed on 28 patients with lower cervical dislocation who received operative treatment between January 2005 and October 2008. There were 19 males and 9 females with an average age of 38 years (range, 19-57 years), including 21 cases of fresh dislocation and 7 cases of old dislocation. The time from injury to hospitalization was 3 hours to 58 days. According to Allen classification, all cases had flexion injury, including 19 cases of degree I dislocation, 2 cases of degree II, 5 cases of degree III, and 2 cases of degree IV. At admission according to Frankel classification, 7 cases were rated as grade A, 4 as grade B, 9 as grade C, 3 as grade D, and 5 as grade E. All patients received open reduction, internal fixation, and iliac bone graft spinal fusion. Of them, combined anterior and posterior approach operation were given in 4 cases, single anterior operation in 22 cases, and single posterior operation in 2 cases.

RESULTS

All operations were completed successfully and the spinal cord injury did not deteriorate after operation. Esophageal fistula occurred in 1 case receiving anterior approach operation and was cured after 1 month. Infection of wound occurred in 1 case and was cured after dressing change. The other incisions healed by first intention. One case (Frankel grade A) died of pulmonary infection 6 weeks after operation. Twenty-seven patients were followed up 21-38 months. Two cases suffered from shoulder pain 12 months after operation. X-ray films showed complete reduction, normal height of vertebral space and normal sequence of cervical spine after operation. All cases obtained bone fusion after 3.5-6.0 months of operation (4.2 months on average). Frankel grades were improved in different degrees after operation.

CONCLUSION

The operation plan of lower cervical dislocation should be determined by the neurologic status of the patient, and the classification of the injury as a unilateral or bilateral dislocation.