Usefulness of osteometric radiological indices to evaluate the effectiveness of surgery treatment of posttraumatic fractures of cervical vertebral column with dislocation

BACKGROUND AND PURPOSE: The aim of this study was to evaluate the effectiveness of surgery treatment in patients with posttraumatic fractures with dislocation of the cervical spine. MATERIAL AND METHODS: A retrospective review was carried out in 24 patients suffering from posttraumatic fractures of cervical spine segments with dislocation treated surgically at the Department and Clinic of Neurosurgery and Neurotraumatology, University of Medical Sciences in Poznan between 1998-2002. The study included 19 (79.2%) males and 5 (20.8%) females, aged from 16 to 60 years (the average age was 35.5). Traumatic lesions of cervical vertebral segments were localized as follows: level C3-C4 - 3 cases; C4-C6 - 17 cases; and at C6-Th1 - 4 cases. A three-grade scale was used to assess the severity of spinal cord trauma. On admission a complete transverse spinal cord syndrome was observed in 6 patients. Radiological investigations included X-ray (24 cases), CT (2 cases) and MRI (22 cases). With this in mind, the osteometric indices of the spine axis deformity were established: the index of anterior displacement of the vertebrae, the angle of local kyphosis (assessed by the Cobb's technique) and the lordosis curvature index. RESULTS: In all cases the operation was performed using the anterior approach. Surgery included anterior decompression and stabilization of the cervical spine by means of a bone graft or acrylic cement and trapezoidal or "S" plate. The postoperative neurological condition improved in 21 (87.5) patients and correction of the cervical axis was achieved in 24 (100%) cases. Postoperative neurological deficits were intensified in 2 cases and were regressive. The mortality rate was 4.2% (1 case). CONCLUSIONS: Osteometric radiological indices enable the bone structure posttraumatic lesions of the cervical vertebral column to be evaluated. This type of internal stabilization makes it possible to restore the alignment of the anterior column and immobilization of the appropriate vertebral segments.