Acta Scientific Orthopaedics (ISSN: 2581-8635)

Case Report Volume 7 Issue 3

Pattern and Radiographic Outcome of Subaxial Extension Injuries of The Cervical Spine: Case Series and Literature Review of The Current Treatment Approach

Ibrahim Fahad AlShugair1, Bander S Alrashedan1, Hussain Alkaff1, Elham AlGhamdi1*, Mohammad Alawad1, Abdallah Alenazi1, Hamid T ALjohani3 and Nasser B Alenezi1, Saad Surur1

1Department of Orthopedic Surgery, Ministry of Health (MOH), King Saud Medical City, Riyadh, Saudi Arabia
2Department of Orthopedic Surgery, Ministry of Health (MOH), Aliman Hospital, Riyadh, Saudi Arabia
3Department of Orthopedic Surgery, Prince Sultan Military Medical City, Saudi Arabia

*Corresponding Author: Elham AlGhamdi, Department of Orthopedic Surgery, Ministry of Health (MOH), King Saud Medical City, Riyadh, Saudi Arabia.

Received: January 31, 2024; Published: February 06, 2024

Abstract

Motor vehicle accidents are a common cause of spine trauma. They are specifically associated with cervical spine fractures. Subaxial facet fractures can present following the hyperextension mechanism and can also be associated with intervertebral disc injuries.

Post-injury loss of lordosis is a feared complication following these injuries. The treatment algorithm available in the literature is unclear as to whether to treat these cases surgically.

A retrospective case series was done on patients who presented to our institute with sub-axial extension Injuries of the cervical spine. The main reported outcome is post-operative sagittal alignment following the treatment modality used in our cases.

Hyperextension mechanism fractures were found in 40.47% (n = 22) of all patients, 19 of whom were hyperextension compression injuries, and 3 were hyperextension distraction injuries. Anterior cervical discectomy and instrumented fusion were shown to maintain post-operative sagittal alignment in all cases with extension injuries. External orthosis showed a 50% prevalence of progressive junctional kyphosis on follow-up.

Anterior cervical discectomy and instrumented fusion have been shown to provide excellent sagittal alignment restoration and maintenance on follow-up, while external orthosis showed a high rate of short-term post-operative junctional kyphosis.

Keywords: Radiographic; Subaxial; Injuries; Cervical Spine

References

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  2. Alawad MO., et al. “Traumatic spinal injuries in Saudi Arabia: a retrospective single-centre medical record review”. BMJ Open11 (2020): e039768.
  3. Divi SN., et al. “AOSpine-Spine Trauma Classification System: The Value of Modifiers: A Narrative Review with Commentary on Evolving Descriptive Principles”. Global Spine Journal 1 (2019): 77S-88S.
  4. Sharif S., et al. “Subaxial Cervical Spine Injuries: WFNS Spine Committee Recommendations”. Neurospine4 (2020): 737-758.
  5. Allen BL., et al. “A mechanistic classification of closed, indirect fractures and dislocations of the lower cervical spine”. Spine (Phila Pa 1976)1 (1982): 1-27.
  6. Raniga SB., et al. “MDCT of acute subaxial cervical spine trauma: a mechanism-based approach”. Insights Imaging3 (2014): 321-338.
  7. Edeiken-Monro B., et al. “Hyperextension dislocation of the cervical spine”. American Journal of Roentgenology 5 (1982): 899-902.
  8. Hadley MN., et al. “Facet fracture-dislocation injuries of the cervical spine”. Neurosurgery 4 (1992): 661-666.
  9. Lifeso RM and Colucci MA. “Anterior fusion for rotationally unstable cervical spine fractures”. Spine (Phila Pa 1976)16 (2000): 2028-2034.
  10. Kim SW., et al. “Analysis of cervical spine alignment in currently asymptomatic individuals: prevalence of kyphotic posture and its relationship with other spinopelvic parameters”. Spine Journal5 (2018): 797-810.
  11. Dvorak MF., et al. “Clinical outcomes of 90 isolated unilateral facet fractures, subluxations, and dislocations treated surgically and nonoperatively”. Spine (Phila Pa 1976)26 (2007): 3007-3013.
  12. Yokota K., et al. “Progression of local kyphosis after conservative treatment for compressive cervical spine fracture with spinal cord injury”. Journal of Orthopaedic Surgery and Research 1 (2019): 98.
  13. Chaput C., et al. “Anterior fixation of floating facet fractures in the cervical spine: a prospective case series and biomechanical analysis”. International Journal of Spine Surgery 2 (2018): 85-91.
  14. Caravaggi P., et al. “Kinematics of the cervical spine after unilateral facet fracture: an in vitro cadaver study”. Spine (Phila Pa 1976)13 (2017): E776-E782.
  15. Totera JIC., et al. “Unilateral Cervical Facet Fractures: Relevance of Acute Disc Injury in Conservative Treatment Failure”. Asian Spine Journal 1 (2023): 30-36.
  16. Harel R., et al. “Cervical Spine Surgery: Approach-Related Complications”. World Neurosurgery 94 (2016): 1-5.
  17. Cabraja M., et al. “Comparison between anterior and posterior decompression with instrumentation for cervical spondylotic myelopathy: sagittal alignment and clinical outcome”. Neurosurgical Focus 3 (2010): E15.
  18. Asiri AM., et al. “Determinants of the Underlying Causes of Mortality during the First Wave of COVID-19 Pandemic in Saudi Arabia: A Descriptive National Study”. International Journal of Environmental Research and Public Health 23 (2021): 12647.
  19. Alawad MO., et al. “Traumatic spinal injuries in Saudi Arabia: a retrospective single-centre medical record review”. BMJ Open 11 (2020): e039768.
  20. Divi SN., et al. “Spine-Spine Trauma Classification System: The Value of Modifiers: A Narrative Review with Commentary on Evolving Descriptive Principles”. Global Spine Journal1 (2019): 77S-88S.
  21. Sharif S., et al. “Subaxial Cervical Spine Injuries: WFNS Spine Committee Recommendations”. Neurospine4 (2020): 737-758.
  22. Allen BL., et al. “A mechanistic classification of closed, indirect fractures and dislocations of the lower cervical spine”. Spine (Phila Pa 1976) 1 (1982): 1-27.
  23. Raniga SB., et al. “MDCT of acute subaxial cervical spine trauma: a mechanism-based approach”. Insights Imaging3 (2014): 321-338.
  24. Edeiken-Monro B., et al. “Hyperextension dislocation of the cervical spine”. American Journal of Roentgenology 5 (1982): 899-902.
  25. Hadley MN., et al. “Facet fracture-dislocation injuries of the cervical spine”. Neurosurgery4 (1992): 661-666.
  26. Lifeso RM and Colucci MA. “Anterior fusion for rotationally unstable cervical spine fractures”. Spine (Phila Pa 1976)16 (2000): 2028-2034.
  27. Kim SW., et al. “Analysis of cervical spine alignment in currently asymptomatic individuals: prevalence of kyphotic posture and its relationship with other spinopelvic parameters”. Spine Journal 5 (2018): 797-810.
  28. Dvorak MF., et al. “Clinical outcomes of 90 isolated unilateral facet fractures, subluxations, and dislocations treated surgically and nonoperatively”. Spine (Phila Pa 1976)26 (2007): 3007-3013.
  29. Yokota K., et al. “Progression of local kyphosis after conservative treatment for compressive cervical spine fracture with spinal cord injury”. Journal of Orthopaedic Surgery and Research 1 (2019): 98.
  30. Chaput C., et al. “Anterior fixation of floating facet fractures in the cervical spine: a prospective case series and biomechanical analysis”. International Journal of Spine Surgery 2 (2018): 85-91.
  31. Caravaggi P., et al. “Kinematics of the cervical spine after unilateral facet fracture: an in vitro cadaver study”. Spine (Phila Pa 1976) 13 (2017): E776-E782.
  32. Totera JIC., et al. “Unilateral Cervical Facet Fractures: Relevance of Acute Disc Injury in Conservative Treatment Failure”. Asian Spine Journal1 (2023): 30-36.
  33. Harel R., et al. “Cervical Spine Surgery: Approach-Related Complications”. World Neurosurgery 94 (2016): 1-5.
  34. Cabraja M., et al. “Comparison between anterior and posterior decompression with instrumentation for cervical spondylotic myelopathy: sagittal alignment and clinical outcome”. Neurosurgical Focus 3 (2010): E15.

Citation

Citation: Hussain Alkaff., et al. “Pattern and Radiographic Outcome of Subaxial Extension Injuries of The Cervical Spine: Case Series and Literature Review of The Current Treatment Approach".Acta Scientific Orthopaedics 7.3 (2024): 06-11.

Copyright

Copyright: © 2024 Hussain Alkaff., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.




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