Operative outcome of unstable lower cervical fracture dislocation by lateral mass screw fixation or anterior plating.

From February 2009 to September 2012, 15 patients (13 males, 2 females; age range, 18-55 years) with the lower cervical fracture dislocation were treated at NRS Medical College, Kolkata. The fracture dislocation occurred in the following cervical segments: C5 (n = 8), C7 (n = 3), C4 (n = 2), and C6 (n = 2). Forteen patients were associated with neurological deficit graded according to ASIA impairment scale. The time interval between Injury and operation was from 3 to 22 days. Eight patients underwent anterior fusion with anterior locked-cervical plate fixation; 7 patients underwent posterior fusion and the lateral mass screw fixation. During each follow-up clinical and radiological parameters were measured; bone fusion and internal fixation condition were observed by x-ray and the neurological recovery was measured by ASIA impairment scale. Follow-up duration was from 3 months to 30 months in different patients which revealed fusion between vertebrae and significant neurological recovery. The fusion time was 4 to 6 months and there was also no instability of vertebrae or loosening of the internal fixation at 12 months. The selection of operative treatment of subaxial cervical spine injury depends upon neurological and radiological criteria. Both posterior and anterior surgical approaches are viable alternatives for treating subaxial spine injuries with different indication and risk profiles. In case of incomplete neurological injury there is significant improvement. Operative treatment certainly decreases the complications related to prolonged immobilisation in recovery phase by making the patient mobile early.