Can posterior ligament structure be functionally healed after anterior reduction and fusion surgery in patients with traumatic subaxial cervical fracture dislocations

Abstract Background The approach selection for subaxial cervical fracture dislocations (SCFD) is controversial. The question of whether a posterior ligamentous structure (PLS) can be functionally healed in the patients with SCFD and how long this healing process takes are critical in these patients. Methods 394 patients with SCFD who underwent anterior decompression, reduction, and fusion between January 2002 and December 2017 were retrospectively enrolled. The definition of functional healing of PLS was based on the evaluations of clinical function and radiographic stability of PLS, which was performed by 3 senior spine surgeons who did not participate in the surgeries. Results A total of 354 patients (89.8%) fulfilled the follow-up. The PLS of 339 cases was functionally healed at the first follow-up interval without any posterior surgical intervention. No hardware failure or progressive cervical kyphosis was observed at further follow-up. At 12 months postoperatively, interbody fusion was satisfactory. However, the other 15 patients experienced non-healing PLS at 8 weeks postoperatively and developed cervical deformity at the further follow-up. Except for 5 patients who refused revision surgery, 10 patients obtained solid fusion after revision surgeries. Conclusion Among 354 patients with SCFD and treated by single anterior reduction and fixation, the simple PLS injury without any bony instability at the posterior column of the cervical spine, can be functionally healed in 95.8% of patients by external fixation for 8 weeks. Whether this finding is applicable to various types of SCFD should be verified in further prospective studies with larger sample.