ARITRA Bidyananda

Introduction- Sub axial cervical spine accounts for about 65% of all cervical spine injuries. Adequate treatment can only be embarked upon after complete understanding of spinal biomechanics and the ability to determine the injury to various anatomical components of the spinal column. The current study discusses the treatment strategies and assesses the outcome of treatment in such injuries. Material & Methods- 36 patients (22 males, 14 females; age range: 18-60 years) with unstable cervical spine injuries (C4 to C7) with neurological deficit graded according to ASIA impairment scale were treated at Assam Medical College & Hospital between June 2010 to September 2014. Patients with bilateral facet dislocation were treated with either posterior or anterior approach after failed preoperative traction. Unilateral facet dislocation was treated with lateral mass fixation or anterior plating. Patients with compressive flexion injury were treated with corpectomy, bone grafting/ cage and anterior plating. Vertical compression fractures were treated with corpectomy, bone grafting and anterior plating. Results & Discussion- The fusion time were 4 to 6 months and there was no residual instability of spine or loosening of the internal fixation at 12 months. Conclusion- Operative treatment of sub axial cervical spine injury decreases the complications related to prolonged immobilization and improves neurological outcomes. Both posterior and anterior surgical approaches are viable alternatives for treating these injuries with different indications and risk profiles. Identifying and understanding the injury, proper selection and planning of cases, preoperative optimisation and thorough knowledge of anatomy is essential to obtain benefits of operative treatment.