[The surgical treatment of injuries of the cervical spine]

The authors' ideas on the management of acute and chronic cervical spine injuries are presented. Unstable fractures and dislocations of the lower cervical spine should be reduced as soon as possible. Most frequently, the authors use the anterior approach and the Smith-Robinson technique with the addition of a H-shaped plate. Posterior fusion is mainly indicated for the release of irreducibly locked facets. Unstable odontoid fractures, especially those in group II according to Anderson and d'Alonzo, are stabilized by internal fixation with a screw. Between 1971 and 1987, 263 patients with lesions of the cervical spine were treated operatively: of these, 169 had acute and 32 chronic injuries; 47 patients had primary tumors or metastases; 15 suffered from arthritis, spondylodiscitis or congenital deformity. The findings in 92 patients (group I) with acute and 24 (group II) with chronic injuries at follow-up are reported. Among the 53 patients in group I with neurologic failure, an improvement was noted in 45 (85%); in 30 cases there was complete restoration of function and 72% of the injured patients became symptom-free. In 71% of those with acute and 58% of those with chronic injuries normal mobility was observed. Regardless of neurologic failure, 89% of patients in group I were able to work after 5 months. The rate of pseudarthrosis was 2%. The risks involved in anterior interbody fusion in the cervical spine are small when a careful and standardized operation technique is used. This allows early functional treatment and shortens the rehabilitation time.