Surgical results of old distractive-flexion injury of subaxial cervical spine: report of ten cases.

BACKGROUND: Acute distractive-flexion injury of subaxial cervical spine (C3-C7) results in facet subluxation or dislocation. However, when the injury is missed or neglected, it may cause serious complications including axial pain, deformity and neurological deficit.

OBJECTIVE: To demonstrate the pathoanatomy, presentation and management of these injuries.

MATERIAL AND METHOD: The present study was conducted retrospectively at Chiang Mai University Hospital during 2008-2011. Ten patients were classified as to whether 2 unilateral/2 bilateral subluxation or 1 unilateral/5 bilateral dislocation. Pain, neurological status, imaging and bony fusion were recorded.

RESULTS: The average timing before achieving treatment was 52 days. Five patients had arm pain and radiculopathy; the other 5 had myelopathy. Nine of 10 patients had posterior element fractures. No disc herniation was found. Pain and neurological status were improved after surgical decompression, realignment, stabilization and fusion. Bony fusions were achieved in all follow-up patients.

CONCLUSION: Most patients have posterior element fractures without any evidence of intervertebral disc herniation. Spinal malalignment is the main cause of neurological impairment. Posterior-anterior approach is the favorable approach for old dislocation. Anterior approach is preferred for subluxation.