Combined anterior and posterior surgical procedure for the treatment of old fracture and dislocation of the lower cervical spine

Objective:To explore into the value of application on surgical treatment of old fracture and dislocation of the lower cervical spine by combined anterior and posterior approach.Methods:Fifteen patients with old fracture and dislocation of the lower cervical spine were involved,all the patients were treated with this technique from July,1997 to June,2002.All the patients were operated under skull traction.First,the posterior approach was carried out,all the patients were operated in general anaesthesia by posterior decompression,unilateral or bilateral articular process crossbite were brisemented.Then the anterior reduction,intervertebral decomperssion,auto-iliac graft and cervical spine locking plate fixation were executed.Results:Fifteen patients were followed-up from 14 months to 6 years and 2 months(34 months in average).All the patients had solid fusion based on flexion and extension radiographs at average of 3.3 months.Fifteen patients got completely reduction,the normal intervertebral height and lordosis were maintained,and there were no complications related to plate and screw loosening,displacement or breakage.There were no neurovascular complications during the operation,and 12 patients with incompletely neurological defect got improved postoperatively.Conclusion:For old fracture-dislocation of the lower cervical spine,an ideal reduction and immediately stability can be obtained by this technique.This method can increase the area of fusion and reduce the rate of nonunion,it gives a completely decompression and a high rate of successful bony fusion.At the same time,it can reduce complications of lying in bed.