Posterior approach for cervical fracture-dislocations with traumatic disc herniation

Area of Science:

• Neurosurgery
• Orthopedic Surgery
• Spinal Surgery

Background:

• Cervical spine fracture-dislocations with disc fragments often necessitate anterior surgical approaches.
• Posterior approaches are less common due to concerns about neurological deterioration during reduction.
• Data on the frequency of neurological deterioration and disc fragment behavior after reduction is limited.

Purpose of the Study:

• To evaluate the safety and efficacy of a posterior-first surgical approach for traumatic cervical disc herniation.
• To assess neurological outcomes and radiological changes following posterior open reduction and arthrodesis.
• To determine the necessity of a secondary anterior approach in the treatment algorithm.

Main Methods:

• Retrospective observation of 40 patients with traumatic disc herniation (29.2% of 137 subaxial cervical spine fracture-dislocation patients).
• Surgical planning followed a two-stage algorithm: initial posterior open reduction and arthrodesis, with anterior surgery considered for residual fragments.
• Postoperative magnetic resonance imaging (MRI) and American Spinal Injury Association (ASIA) impairment scale assessments were utilized.

Main Results:

• No neurological deterioration was observed after posterior open reduction.
• 25% of all patients and 75% of those with incomplete paralysis showed improvement (≥ 1 ASIA grade).
• Postoperative MRI confirmed reduction/reversal of disc herniation in all cases; significant improvements in sagittal alignment and disc height were noted.

Conclusions:

• The posterior approach for traumatic cervical disc herniation is associated with zero incidence of neurological deterioration.
• Favorable clinical and radiological outcomes can be achieved with posterior open reduction and arthrodesis alone.
• The need for secondary anterior surgery is minimal, though preparedness is advised.