Results Of Anterior Fixation for Subaxial Cervical Injuries in A Tertiary Care Centre

Abstract

Sub-axial injuries of cervical spine involving posterior ligaments, articular facets and pillars are communal, and surgical treatment is debatable, and studies describe variable consequences from combined access of anterior and posterior approach or separately Objective: To assess the outcome of early (<72 hours) anterior cervical discectomy and fusion with plating for injuries of the sub-axial cervical spine. Methods: A retrospective analysis, from January 2018 to December 2020 was conducted in a tertiary care referral center. 110 patients (67 male, 43 females; mean age 51.1 years; range 19-80 years) who endured anterior cervical discectomy (ACD) at single-level and fusion (ACDF using a polyetheretherketone, (PEEK, cage) with plate fixation for injuries of sub-axial cervical spine were evaluated. Radiological evaluation was done considering fusion, segmental height (SH), advancement of adjacent segment disease (ASD) and lordosis (Cobb Angle). Clinical results were evaluated by means of visual analogue scale (VAS) for neck pain and Frankel Grading for neurological function Results: The cervical trauma was instigated by road traffic accident (RTA) in 69 cases, slip down in 16 cases and a fall from a height in 25 cases. Simple lateral cervical X-rays and CT with reconstruction were taken in all subjects and showed dislocation or subluxation of C3 to C4 in 15 patients, 39 patients with C4 to C5 dislocation, 32 patients with C5 to C6 dislocation and C6 to C7 in 24 patients. The preoperative mean Cobb angle was -3.9 ± 8.01 °. 4.1 ± 6.6 ° was the mean Cobb angle instantly later to treatment and 1.8 ± 4.7 ° at the final visit. The operation brings a substantial decrease in the regional kyphotic angle (p <0.05). The SH mean before surgery was 37.01 ± 1.9 mm. The SH mean was 41.2 ± 1.9 mm instantly after operation and 37.9 ± 1.9 mm at the final visit. The mean rise in height at the end of observation was 0.9 mm. The variance between pre-operative SH measurements and final SH was significant (p <0.05). An improvement of VAS from 8.4±1.01 to 2.8±1.6 at 12 months was statistically significant. There was also an improvement in 19.1% of cases for at least one Frenkel grade at 12 months follow-up. Conclusions: The fusion with a PEEK cage and the fixation with anterior cervical plate resulted in satisfactory clinical results and high fusion rates deprived of any morbidity at the donor-site. This procedure is effective and safe for single-level sub-axial injuries of the cervical spine