Locking screw-plate fixation of cervical spine fractures with and without ancillary posterior plating

Forty consecutive patients with 19 fractures and 21 fracture-dislocations in the lower cervical spine were treated prospectively with open reduction and interbody fusion, using the AO titanium locking screw-plate system. There were 30 men and 10 women with a mean age of 36 years (range 16-90 years). Eight were admitted tetraplegic, 12 tetraparetic, and 6 had nerve root injuries. Eleven of the fractures and 18 of the fracture-dislocations were also plated posteriorly. Complications included two cardiac arrests, two transient neurological impairments, two severe gastrointestinal bleedings, and one esophageal fistula. At 2-year follow-up, three patients had died and one had emigrated. Three out of ten patients who had complete motor loss initially had regained useful muscle function, while incomplete motor loss usually returned to normal. All fusions had healed in a good or acceptable position. Twenty-four of the 60 posterior plates impinged on facet joints and five were loose. Six screws transgressed facet joints below the fusion. Ten posterior fusions extended to adjacent mobile segments by exuberant bony overgrowth. Ancillary posterior plating significantly reduced the range of neck mobility and also caused significantly more pain than anterior plate fixation alone.