Gattozzi Domenico A, Yekzaman Bailey R, Jack Megan M, O'Bryan Michael J, Arnold Paul M
Department of Neurosurgery, University of Kansas Medical Center, 3901 Rainbow Boulevard, Mail Stop 3021, Kansas City, KS, U.S.A.
Medical Student, University of Kansas Medical School, 3901 Rainbow Boulevard, Kansas City, KS, U.S.A.
Surg Neurol Int. 2018 Dec 13;9:254. doi: 10.4103/sni.sni_352_18. eCollection 2018.
Spinal cord decompression after cervical spinal cord injury (SCI) is the standard of care. However, there is a lack of consensus regarding the optimal management of these injuries, including the role of traction and timing of surgery. Here, we report the safety/efficacy of ventral surgery without preoperative traction for intraoperative fracture reduction following acute cervical SCI.
We prospectively collected a series of patients who sustained acute traumatic subaxial cervical (C3-7) spine fractures between 2004 and 2016. Patients underwent anterior cervical decompression and fusion within 24 h of injury without the utilization of preoperative traction.
Thirty-six patients (27 male, 9 female), averaging 35 years of age, sustained 25 motor-vehicle accidents, 4 sports-related injuries, and 7 falls. Fracture dislocations were seen in 26 patients, whereas burst fractures were seen in 10. The majority of injuries occurred at the C4-5 (13 patients) and C5-6 (13 patients) levels. Complete SCI occurred in 10 patients, and incomplete SCI in 26 patients. All patients underwent anterior surgery only; 16 required vertebrectomy in addition to anterior cervical discectomy and fusion. Intraoperative reduction was achieved in all patients using a Cobb elevator or distraction pins without the use of preanesthesia traction. There were no intraoperative complications. Postoperatively, there were one postoperative hematoma, two wound/hardware revisions, one subsequent posterior fusion, and one reoperation anteriorly after screw pullout. The average hospital length of stay was 10.6 days (range 1-39).
Early direct surgical stabilization/fusion for acute SCI because of subaxial cervical spine fractures is both safe and effective in selected cases when performed anteriorly without preoperative traction in select cases.
颈椎脊髓损伤（SCI）后进行脊髓减压是治疗的标准方法。然而，对于这些损伤的最佳治疗方案，包括牵引的作用和手术时机，目前尚无共识。在此，我们报告急性颈椎SCI后在术中不进行术前牵引的情况下进行前路手术复位骨折的安全性/有效性。
我们前瞻性收集了2004年至2016年间发生急性创伤性下颈椎（C3 - 7）脊柱骨折的一系列患者。患者在受伤后24小时内接受了前路颈椎减压融合术，未使用术前牵引。
36例患者（男性27例，女性9例），平均年龄35岁，发生25起机动车事故、4起与运动相关的损伤和7次跌倒。26例患者出现骨折脱位，10例为爆裂骨折。大多数损伤发生在C4 - 5（13例患者）和C5 - 6（13例患者）水平。10例患者发生完全性SCI，26例为不完全性SCI。所有患者仅接受了前路手术；16例患者除前路颈椎间盘切除融合术外还需要进行椎体切除术。所有患者均使用Cobb骨膜剥离子或撑开钉在术中完成复位，未使用麻醉前牵引。术中无并发症。术后，有1例术后血肿、2例伤口/内固定物翻修、1例随后进行后路融合以及1例螺钉拔出后再次进行前路手术。平均住院时间为10.6天（范围1 - 39天）。
对于下颈椎骨折导致的急性SCI，在某些情况下，早期直接进行手术稳定/融合，在不进行术前牵引的情况下从前路进行手术是安全有效的。
