A Brief Study On Clinical Outcome following Anterior Cervical Decompression And Fusion With Locking Anterior Cervical Plate

Abstract

INTRODUCTION:When a neurological deficiency is present in cervical spinal injuries, it can have a severe effect and increase morbidity and death. Five percent of trauma patients have spinal injuries, with cervical spinal injuries accounting for more than half of these cases. The focus of this study is the analysis of the functional result and cervical spine injury recovery treated with locking titanium anterior cervical plate stabilization and anterior cervical decompression and fusion for sub-axial cervical spinal injuries.

MATERIALS AND METHODS: This retrospective study, which was carried out between January 2021 and January 2022, comprised 20 patients with neurological deficits resulting from cervical spine injuries who were hospitalized at the orthopaedic department of Saveetha Medical College Hospital in Chennai. Fracture dislocation and subaxial cervical fracture were the only two conditions for inclusion. Multiple spine injuries and SCIWORA (Spinal Cord Injury without Radiological Abnormalities) were the exclusion criteria. Five of the twenty cases involved complete spinal cord injuries, whereas the other fifteen cases involved incomplete injuries. ASIA grading was used to evaluate each case's clinical status before surgery. Open mouth, lateral, X-ray, oblique, swimmer's lateral views, CT, & MRI scans were also performed, and the results were recorded. The treatment that was carried out involved fusion, anterior cervical decompression, and stability utilizing a locking titanium anterior cervical plate. Following the tenth day of suture removal, patients are discharged from the hospital based on their improved neurological condition. In the sixth and twelfth weeks, flexion and extension X-rays are used to evaluate the fusion. If solid fusion is observed, the collar is taken off, and gradual neck motions are initiated. For the first six months, the patient is checked monthly; after that, they are examined every two months, and finally, every six months.

RESULT: Our study's most prevalent age group was 25 to 35 years, comprising 10 (or 50%) of the patients. The minimum age in the current research was 19 years. The maximum age in the current research was 68 years. The mean age in the current research was 32.2 years (Range between 19 to 68 years). No patients were lost to follow-up in our study. There were 12 males (60%) and 8 females (40 %). Traffic accidents account for the majority of injuries (55%) while accidental falls account for 25% of injuries. Thirteen patients (65%) in the present study group have partial spinal cord injuries, such as ASIA grades B and C. Just five patients—or 25%—had a total spinal cord injury.

CONCLUSION: Neurological recovery is facilitated by surgical decompression and fusion combined with stabilization, particularly in cases of partial cord damage. Overall, for anterior cervical decompression, acute sub-axial cervical spinal injuries, and fusion using a tri-cortical iliac graft is a safe technique with a high incidence of pain alleviation, functional improvement, and neurological recovery. By employing locking anterior cervical plating, grafting problems such as graft failure and kyphotic deformity were decreased, and the fusion rate was increased. In our series, there was no plate and graft or screw failure. Young age with partial lesion healed rather well.