Anterolateral Operations for Fractures and Dislocations in the Middle and Lower Parts of the Cervical Spine

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Abstract
A follow-up study of forty-seven patients treated for traumatic lesions of the cervical spine with and without associated neural deficits is presented. Operation was performed six hours to eight months after injury. The objectives of these procedures were to remove any causes of compression of the cord or nerve roots, especially anterior compression, to reduce the dislocation and kyphosis, and to stabilize the cervical spine by interbody fusion. Preoperative and postoperative care is described as well as the exposure used for different levels of the spine and the three types of bone-grafting procedures that were developed to correct and stabilize the deformities associated with the various fractures and fracture-dislocations encountered. Normal or satisfactory alignment was regained in all but three of the forty-one surviving patients, and solid fusion occurred in the forty-one surviving patients who were followed long enough to determine the results of fusion. There was no evidence that the operation had aggravated any neural deficits, although in two of the six patients who died after acute complete transverse cord lesions it was thought that early operation within twelve hours of injury may have contributed to the fatal outcome. The functional results of operation in terms of relief of neck pain and recovery of cord and nerve-root function were encouraging. The prompt recovery of function of a few patients who had not improved after as long as 3.5 months of non-operative treatment suggested that reduction of the dislocation and correction of the kyphosis, combined with removal of the posteriorly extruded disc material in nine patients, had corrected a vascular insufficiency. It was concluded that anterolateral operations may be harmful for patients with acute complete transverse lesions of the cord but that traumatic abnormalities causing compression of the anterior part of the cord or traction and consequent anterior pressure on the cord (the result of angulation of the cervical spine) can be eliminated or corrected under direct vision in a way not possible by laminectomy. It was further concluded that fusion is easily effected through the anterolateral approach, whereas after laminectomy posterior fusion may be difficult or impossible.

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