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Journal of Korean Neurosurgical Society 1973;2(2): 83-94.
Anterior Interbody Fusion for Cervical Fracture-Dislocations.
Kwang Myung Kim
Department of Neurosurgery, Medical School, Han-Yang University, Korea.
Cervical fracture-dislocation continue to be a difficult therapeutic problem. It gives more prolonged and complexing neurological deficits and complications than any other injuries. Since the introduction of skull tongs for skeletal traction by Crutchfield in 1933, very little had been added to treat cases until the works of Dereymaeker, Smith and Robinson, and Cloward who introduced the value of anterior approach for cervical fracture-dislocations around 1955. The author reviewed 51 cases of cervical fracture-dislocation treated at Severance Hospital and Hanyang University Hospital from 1964 to 1972; 23 cases were treated by simple traction, 27 cases by anterior interbody fusion, and one cases by posterior internal splint using resin and wiring. 1. Early anterior approach offers a unique opportunity to treat the lesion under direct vision. The spinal instability can be corrected by a vertebral fusion, and prolonged immobilization in skull traction may be avoided. 2. Myelography and Queckenstedt's test is not indicated except in the few limited cases to find ruptured disc lesions. 3. Acute ruptured disc was found in almost all the surgical cases. In many cases, disc removal was imperative after conservative therapy. And interbody fusion gives the best prognosis. 4. For the reduction of new locked facets, posterior approach is easier and safer than anterior approach. But in the case of old locked facets, all scar tissue should be excised via anterior approach before performing posterior approach. 5. Postoperative anterior angulation of cervical spine resulted from compression of vertebral body at the time of injury, and it may be prevented by hyperextended surgical position of the cervical spine during interbody fusion and postoperative fraction for two to three weeks.
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