Corpectomy and anterior plating in cervical spine fractures with tetraplegia

Between 1980 and 1989, 68 tetraplegic patients (69 males and 8 females) with cervical spine fractures were treated with corpectomy, iliac bone grafting and anterior plating. The average age was 27 years (15-58 years). The resected vertebrae was C4 in 4 cases, C5 in 24, C6 in 32 and C7 in 8. The injuries were classified according to Allen et al. in: compressive flexion in 47 cases, vertical compression in 20 and distractive flexion in 1. The neurologic deficit was complete in 30 patients and incomplete in 38 patients. The surgery was performed 7 days (average) (1-28 days) after the trauma. The mean follow-up was 2.8 years (1-9 years). In the postoperative period early mobilization was permitted with a plastic collar. There were 6 deaths that were not related to the technique in the first 4 weeks; the results of the remaining 62 patients are presented hereafter. In the final follow-up we observed that 56 patients had no complications related to the procedure and the spine was stabilized. The following complications were observed in the remaining patients: 5 partial loosening of the plate, but the patients were asymptomatic and 1 complete loosening that was reoperated after 2 weeks. The motor indices improved from 12.4 points initially to 23.7 in the complete tetraplegics and from 30.2 points to 72.5 in the incomplete tetraplegics. We conclude that the anterior plate fixation after anterior decompression for cervical spine fractures avoids the extrusion of the graft and provides immediate stabilization of the spine, permitting early mobilization of the patients.