Purpose of Study To compare the advantages and disadvantages of anterior and posterior approaches for treatment of subaxial cervical dislocation and fracture subluxation.
Methods Used A retrospective review was performed of all patients undergoing operative treatment for subaxial facet dislocations and fracture subluxation from December 2000 through September 2005. X-rays were measured for preoperative and postoperative kyphosis and anterolisthesis. X-rays were also examined for fusion quality at final follow-up and for loss of reduction or implant failure. Surgical variables were recorded, including EBL and postoperative wound complications. Twenty-six patients were identified meeting inclusion criteria, 8 treated by anterior methods, 18 treated by posterior fusion and plating.
Summary of Results The anterior cervical fixation procedure was noted to be associated with a greater correction of posttraumatic kyphosis with a mean correction of 13 degrees. The mean kyphosis in the anterior group was 8 degrees preoperative, correcting to a mean postoperative value of -5 degrees (p = .003). In the posterior fusion and plating group the mean preoperative value for kyphosis was 7 degrees, correcting to a postoperative mean of 1 degree (p = .03). There was also significantly less blood loss in the anterior group than on the posterior treatment group with mean EBL of 90 cc and 258 cc respectively (p = .008). There were no wound complications in the anterior treatment group while there were four postoperative wound infections in the posterior treatment group requiring irrigation and débridement.
Conclusions Reached Anterior stabilization is a valid alternative to posterior stabilization in the treatment of facet dislocations and subluxation and may be preferred in the treatment of the polytrauma patient.
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