Anterior decompression and internal fixation for lower cervical spine dislocation

Objective: To summarize neurological outcome and complications after skull distraction combination of anterior cervical surgery managed with corpectomy, titanium mesh cage reconstruction, and cervical locking plate. Methods: A total of 42 patients with lower cervical spine fracture and dislocation were included in this study between May 2009 and September 2014. The average follow-up time was 18.3 months (ranges 8-24 months). After diagnosed clearly at admission, all patients were used of skull traction. If closed reduction failed, anterior decompression and corpectomy were performed. Titanium mesh cage filled with autograft removed from vertebral and locking plates were applied. The cervical reduction, stabilization, recovery of neurological function, and bone fusion were evaluated for the patients. Results: All patients were achieved reduction successfully and recovered the normal cervical alignment. There were no significant complications occurred during operation. Bone fusion occurred, while implant loosening, pseudarthrosis, and graft settling were not observed in six months follow-up. Dysphagia was noted in two patients and odynophagia in one patient. These two clinical symptoms disappeared without special treatment after three months. No patient was found neurological worsening during preoperative skull traction. There were 12 patients without ASIA level or upper extremity function improvement in 1 year follow-up. The postoperative ASIA grades of the thirty patients were increased at least one level. Conclusions: For the lower cervical fracture and dislocation, preoperative skull traction acting as an initial treatment is safe and effective to restore dislocation to some extent and minimize neurological function deteriorating. If this failed, anterior surgical fixation of using titanium mesh cage and locking plate is a proper choice for short operation time, little hemorrhage volume, low complication rate, and high fusion rate.