Conundrum in surgical management of three-column injuries in sub-axial cervical spine: a systematic review and meta-analysis.
Anterior approach
Cervical spine
Combined approach
Posterior approach
Spine trauma
Three-column injury
Journal
European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
ISSN: 1432-0932
Titre abrégé: Eur Spine J
Pays: Germany
ID NLM: 9301980
Informations de publication
Date de publication:
Feb 2022
Feb 2022
Historique:
received:
21
09
2021
accepted:
18
11
2021
revised:
03
11
2021
pubmed:
4
12
2021
medline:
7
4
2022
entrez:
3
12
2021
Statut:
ppublish
Résumé
Systematic Review and Meta-analysis. Three-column injuries making the spine unstable require adequate fixation which can be achieved by anterior alone, posterior alone or combined anterior-posterior approach. There is no general consensus till date on a single best approach in sub-axial cervical spine trauma. This study comparing the three approaches is an attempt to establish a firmer guideline in this disputed topic. The protocol was registered with PROSPERO. PubMed, Embase and Google Scholar were searched for relevant literature. For each study, pre-defined data were extracted which included correction of kyphosis, loss of correction, hospital stay, operative time, blood loss during surgery as the outcome variables. Studies were also screened for the complications. Eleven studies were evaluated for qualitative analysis and quantitative synthesis of the data in our review. The result demonstrated significant difference with most correction achieved in combined approach subgroup. Though no significant difference was found, the anterior group was having maximum loss of correction. Combined approach showed significantly more operative time and blood loss followed by posterior approach and then anterior approach alone. The improvement in VAS was significantly more in anterior subgroup when compared to combined approach. Cervical alignment is best restored by combined approach compared to the other two. Anterior only approach showed more correction than posterior approach. However, there is no significant difference between all three approaches in loss of correction at long-term follow-up. Anterior only approach is superior to posterior and combined approach on basis of intraoperative and perioperative parameters. Diagnostic: individual cross-sectional studies with the consistently applied reference standard and blinding.
Identifiants
pubmed: 34859269
doi: 10.1007/s00586-021-07068-9
pii: 10.1007/s00586-021-07068-9
doi:
Types de publication
Journal Article
Meta-Analysis
Review
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
301-310Informations de copyright
© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.
Références
Goldberg W, Mueller C, Panacek E, Tigges S, Hoffman JR, Mower WR (2001) Distribution and patterns of blunt traumatic cervical spine injury. Ann Emerg Med 38(1):17–21. https://doi.org/10.1067/mem.2001.116150
doi: 10.1067/mem.2001.116150
pubmed: 11423806
Sekhon LHS, Fehlings MG (2001) Epidemiology, demographics, and pathophysiology of acute spinal cord injury. Spine. https://doi.org/10.1177/2192568217694002
doi: 10.1177/2192568217694002
pubmed: 11805616
Anissipour AK, Agel J, Baron M, Magnusson E, Bellabarba C, Bransford RJ (2017) Traumatic cervical unilateral and bilateral facet dislocations treated with anterior cervical discectomy and fusion has a low failure rate. Glob Spine J 7(2):110–115. https://doi.org/10.1177/2192568217694002
doi: 10.1177/2192568217694002
Kwon BK, Vaccaro AR, Grauer JN, Fisher CG, Dvorak MF (2006) Subaxial cervical spine trauma. JAAOS J Am Acad Orthop Surg 14(2):78
doi: 10.5435/00124635-200602000-00003
Sethy SS, Ahuja K, Ifthekar S, Sarkar B, Kandwal P (2021) Is anterior-only fixation adequate for three-column injuries of the cervical spine? Asian Spine J 15(1):72–80. https://doi.org/10.31616/asj.2019.0225
doi: 10.31616/asj.2019.0225
pubmed: 32321199
Pateder DB, Carbone JJ (2005) Lateral mass screw fixation for cervical spine trauma: associated complications and efficacy in maintaining alignment. Spine J 6(1):40–43. https://doi.org/10.1016/j.spinee.2005.04.010
doi: 10.1016/j.spinee.2005.04.010
Belirgen M, Dlouhy BJ, Grossbach AJ, Torner JC, Hitchon PW (2013) Surgical options in the treatment of subaxial cervical fractures: a retrospective cohort study. Clin Neurol Neurosurg 115(8):1420–1428. https://doi.org/10.1016/j.clineuro.2013.01.018
doi: 10.1016/j.clineuro.2013.01.018
pubmed: 23481897
Zaveri G, Das G (2017) Management of sub-axial cervical spine injuries. Indian J Orthop 51(6):633–652. https://doi.org/10.4103/ortho.IJOrtho_192_16
doi: 10.4103/ortho.IJOrtho_192_16
pubmed: 29200479
pmcid: 5688856
Tofuku K, Koga H, Yone K, Komiya S (2012) Distractive flexion injuries of the subaxial cervical spine treated with a posterior procedure using cervical pedicle screws or a combined anterior and posterior procedure. J Clin Neurosci 20(5):697–701. https://doi.org/10.1016/j.jocn.2012.03.045
doi: 10.1016/j.jocn.2012.03.045
Dvorak MF, Itshayek E, Fehlings MG et al (2015) International spinal cord injury: spinal interventions and surgical procedures basic data set. Spinal Cord 53(2):155–165. https://doi.org/10.1038/sc.2014.182
doi: 10.1038/sc.2014.182
pubmed: 25420492
Dvorak MF, Fisher CG, Fehlings MG et al (2007) The surgical approach to subaxial cervical spine injuries: an evidence-based algorithm based on the SLIC classification system. Spine 32(23):2620
doi: 10.1097/BRS.0b013e318158ce16
Joaquim AF, Patel AA (2013) Subaxial cervical spine trauma: evaluation and surgical decision-making. Glob Spine J 4(1):63–69. https://doi.org/10.1055/s-0033-1356764
doi: 10.1055/s-0033-1356764
Jack A, Hardy-St-Pierre G, Wilson M, Choy G, Fox R, Nataraj A (2017) Anterior surgical fixation for cervical spine flexion-distraction injuries. World Neurosurg 101:365–371. https://doi.org/10.1016/j.wneu.2017.02.027
doi: 10.1016/j.wneu.2017.02.027
pubmed: 28213193
Han M-S, Lee G-J, Kim J-H, Lee S-K, Moon BJ, Lee J-K (2018) Outcomes of anterior cervical fusion using polyetheretherketone cage with demineralized bone matrix and plate for management of subaxial cervical spine injuries. Korean J Neurotrauma 14(2):123–128
doi: 10.13004/kjnt.2018.14.2.123
Kim S-H, Lee J-K, Jang J-W, Park H-W, Hur H (2017) Polyetheretherketone cage with demineralized bone matrix can replace iliac crest autografts for anterior cervical discectomy and fusion in subaxial cervical spine injuries. J Korean Neurosurg Soc 60(2):211–219. https://doi.org/10.3340/jkns.2015.0203.014
doi: 10.3340/jkns.2015.0203.014
pubmed: 28264242
pmcid: 5365290
Miao D, Zhang B, Lei T, Shen Y (2017) Clinical efficacy of anterior partial corpectomy and titanium mesh fusion and internal fixation for treatment of old fracture dislocation of the lower cervical spine. Med Sci Monit 23:5675–5682. https://doi.org/10.12659/MSM.907470
doi: 10.12659/MSM.907470
pubmed: 29184051
pmcid: 5717993
Nakashima H, Yukawa Y, Ito K, Machino M, El Zahlawy H, Kato F (2011) Posterior approach for cervical fracture–dislocations with traumatic disc herniation. Eur Spine J 20(3):387–394. https://doi.org/10.1007/s00586-010-1589-1
doi: 10.1007/s00586-010-1589-1
pubmed: 20936307
Park JH, Roh SW, Rhim SC (2015) A single-stage posterior approach with open reduction and pedicle screw fixation in subaxial cervical facet dislocations. J Neurosurg Spine SPI 23(1):35–41. https://doi.org/10.3171/2014.11.SPINE14805
doi: 10.3171/2014.11.SPINE14805
Feng G, Hong Y, Li L et al (2012) Anterior decompression and nonstructural bone grafting and posterior fixation for cervical facet dislocation with traumatic disc herniation. Spine 37(25):2082
doi: 10.1097/BRS.0b013e31825ee846
Ding C, Wu T-K, Gong Q et al (2017) Anterior release and nonstructural bone grafting and posterior fixation for old lower cervical dislocations with locked facets. Medicine 96(46):e8809
doi: 10.1097/MD.0000000000008809
Jiang X, Yao Y, Yu M, Cao Y, Yang H (2017) Surgical treatment for subaxial cervical facet dislocations with incomplete or without neurological deficit: a prospective study of 52 cases. Med Sci Monit 23:732–740. https://doi.org/10.12659/MSM.902961
doi: 10.12659/MSM.902961
pubmed: 28182597
pmcid: 5314735
Del Curto D, Tamaoki MJ, Martins DE, Puertas EB, Belloti JC (2014) Surgical approaches for cervical spine facet dislocations in adults. Cochrane Datab Syst Rev. https://doi.org/10.1002/14651858.CD008129.pub2
doi: 10.1002/14651858.CD008129.pub2
Vaccaro AR, Madigan L, Schweitzer ME, Flanders AE, Hilibrand AS, Albert TJ (2001) Magnetic resonance imaging analysis of soft tissue disruption after flexion-distraction injuries of the subaxial cervical spine. Spine 26(17):1866
doi: 10.1097/00007632-200109010-00009
Kim KH, Cho DC, Sung JK (2007) The management of bilateral interfacetal dislocation with anterior fixation in cervical spine: comparison with combined antero-posterior fixation. J Korean Neurosurg Soc 42(4):305–310. https://doi.org/10.3340/jkns.2007.42.4.305
doi: 10.3340/jkns.2007.42.4.305
pubmed: 19096561
pmcid: 2588208
Ianuzzi A, Zambrano I, Tataria J et al (2006) Biomechanical evaluation of surgical constructs for stabilization of cervical teardrop fractures. Spine J 6(5):514–523. https://doi.org/10.1016/j.spinee.2005.12.001
doi: 10.1016/j.spinee.2005.12.001
pubmed: 16934720
Lee W, Wong CC (2021) Anterior-alone surgical treatment for subaxial cervical spine facet dislocation: a systematic review. Glob Spine J 11(2):256–265. https://doi.org/10.1177/2192568220907574
doi: 10.1177/2192568220907574
Do Koh Y, Lim T-H, Won You J, Eck J, An HS (2001) A biomechanical comparison of modern anterior and posterior plate fixation of the cervical spine. Spine 26(1):15
doi: 10.1097/00007632-200101010-00005
Johnson MG, Fisher CG, Boyd M, Pitzen T, Oxland TR, Dvorak MF (2004) The radiographic failure of single segment anterior cervical plate fixation in traumatic cervical flexion distraction injuries. Spine 29(24):2815
doi: 10.1097/01.brs.0000151088.80797.bd
Theodotou CB, Ghobrial GM, Middleton AL, Wang MY, Levi AD (2018) Anterior reduction and fusion of cervical facet dislocations. Neurosurgery 84(2):388–395. https://doi.org/10.1093/neuros/nyy032
doi: 10.1093/neuros/nyy032
Song K-J, Lee K-B (2008) Anterior versus combined anterior and posterior fixation/fusion in the treatment of distraction-flexion injury in the lower cervical spine. J Clin Neurosci 15(1):36–42. https://doi.org/10.1016/j.jocn.2007.05.010
doi: 10.1016/j.jocn.2007.05.010
pubmed: 18061456
Kwon BK, Fisher CG, Boyd MC et al (2007) A prospective randomized controlled trial of anterior compared with posterior stabilization for unilateral facet injuries of the cervical spine. J Neurosurg Spine SPI 7(1):1–12. https://doi.org/10.3171/SPI-07/07/001
doi: 10.3171/SPI-07/07/001
Ren C, Qin R, Wang P, Wang P (2020) Comparison of anterior and posterior approaches for treatment of traumatic cervical dislocation combined with spinal cord injury: minimum 10-year follow-up. Sci Rep 10(1):10346. https://doi.org/10.1038/s41598-020-67265-2
doi: 10.1038/s41598-020-67265-2
pubmed: 32587305
pmcid: 7316727
Lins CC, Prado DT, Joaquim AF (2016) Surgical treatment of traumatic cervical facet dislocation: anterior, posterior or combined approaches? Arq Neuro Psiquiatr 74(9):745–749. https://doi.org/10.1590/0004-282X20160078
doi: 10.1590/0004-282X20160078