Is Anterior-Only Fixation Adequate for Three-Column Injuries of the Cervical Spine?

Study Design: Retrospective case series.

Purpose: To analyze the clinical and functional outcomes of patients who have undergone anterior cervical discectomy/corpectomy and fusion (ACDF/ACCF) for a three-column cervical spine injury (CSI).

Overview Of Literature: The treatment of choice for a three-column CSI is an area of contention; however, combined anterior and posterior fixation is the preferred method explored in the literature. Studies have shown the superior biomechanical stability of posterior fixation over that of anterior fixation, but anterior-only approach in CSI has been proving its efficacy in recent times by providing reasonable stability with the maximum achievable decompression and fusion.

Methods: Twenty-one patients undergoing ACDF/ACCF with a bone graft/metallic cage treatment for cervical injuries involving all three columns from January 2016 to July 2018 were included in the study. All of the patients were followed up monthly for the first 3 months and then every 6 months, until their last follow-up visit.

Results: Nineteen patients had AO type C injuries and were managed with ACDF, and two patients with AO type B injuries were managed with ACCF. Fifteen had a complete spinal cord injury, while six had an incomplete spinal cord injury (American Spinal Injury Association B, C, and D). The mean segmental kyphosis at presentation of 12.2°±4.4° improved in the postoperative period to -7.2°±2.5°. At their final follow-up, all the patients showed clinical improvements when assessed by the Visual Analog Scale (6.8-1.8), Oswestry Disability Index score (59.7-34.9), and Spinal Cord Independence Measure score (24.8-36.4). One patient in the ACDF group needed a secondary posterior fixation because of instability.

Conclusions: An anterior approach to the cervical spine in cervical fracture dislocations is an effective treatment showing an optimal recovery rate in terms of patient-reported outcomes and structural stability, with the added advantages of less blood loss and the fact that the technique requires less instrumentation.