Stage I compression-extension injury of the cervical spine. A rotationally unstable injury

Stage I compression-extension injury of the cervical spine, as described by Allen et al, is not always a stable injury. The combined unilateral failure of the posterior structures under compression together with failure of the anterior structures under tension will lead to rotational instability around the intact lateral mass. We report on 10 consecutive patients who presented with this type of injury. The surgical protocol consisted of early reduction followed by anterior cervical fusion using a tricortical iliac graft and a locking plate. Mean follow-up was 38.5 months. Intra-operative assessment revealed disc injury in all patients. Anatomical realignment and solid fusion were achieved in all cases. All 10 patients showed improvement of their neurological deficit. One patient remained with some residual weakness in his triceps, and another required removal of a prominent screw.