Abstract
STUDY DESIGN: Prospective case series. OBJECTIVE: To evaluate the efficacy of anterior-only approach, for treatment of type C F4 (AO classification) traumatic subaxial cervical spine injuries. METHODS: Patients with type C F4 traumatic cervical injuries presenting to a tertiary center between June 2017 and July 2018 were included. Outcome measures included self-reported measures (Neck Disability Index, visual analogue scale, and return to work), radiological measures (local segmental angle, Ishihara curvature index, cervical lordosis angle, and step-off distance), fusion state, and neurological state according to American Spinal Injury Association (ASIA) Impairment Scale (AIS). RESULTS: Twenty-one cases were operated by anterior approach with mean age 39.1 ± 13.8 years. The most common injury was at C4-5 (47.6%). Six out of 7 cases (85.7%) with preoperative neurological impairment showed late follow-up improvement by one or more grade in AIS. Complete anatomical reduction and imaging measures did not correlate significantly to the self-reported outcome measures. Median value of local segmental angle improved from -16° (-11° to -20) preoperatively to 0° (-7°) to 8°) at late follow-up. The cervical lordotic angle and Ishihara curvature index improved from 35° (29° to 43°) and 6.92 (-2.7 to 28.9) preoperatively, to 44° (33° to 51°) and 18.7 (-3.5 to 26.9) at the late follow-up, respectively. Step-off distance decreased postoperatively, however; complete reduction could not be achieved. CONCLUSION: Surgical treatment of lower cervical traumatic instability by anterior decompression and fusion is efficient regarding fusion state and patients' satisfaction. The anterior approach can be recommended in cases with neurological impairment and in patients with medical comorbidities or when a short operative time-compared with combined approach-is preferred.