Fracture of the cervical spine. Operative results and neurological outcome

Introduction: The strategy of the treatment is discussed and the results of the operative treatment in dependency of the neurological situation are critically evaluated. Method: Catamnestic and clinical follow-up was available of 270 patients who had been operated in our hospital because of a discoligamental and/or osseous injury of the middle and lower cervical spine. We analysed the mechanism of the accident, the localization of the injury and the frequency, the results of the neurological post traumatic examination, the age related pattern of the injury and the method of the operations. Results: The most frequent causes of the accidents were traffic accidents (46%) and diving (?) accidents (38%). A postoperative improvement of the clinical symptoms was found in 10 percent of those with a complete transverse lesion, in 69 percent of the patients with an incomplete transverse lesion and in 92 percent of the patients with radicular symptoms. The segments C5/6 and C6/7 were involved in most cases. In polysegmental injuries the segments C4/5/6 are dominating. Conclusion: The ventral interbody-fusion according to the technique of Cloward-Crock or Bailey-Badgley with monosegmental or bisegmental plate fixation provided the best results.