Stabilization does not guarantee neurological recovery but prevents deterioration in the management of AO type-B Sub axial cervical spine injuries: 15 years clinic- radiological outcome from a retrospective cohort analysis

Abstract
Study Design: Retrospective cohort analysis. Purpose: To evaluate the long-term clinical and radiological outcome of AO type-B Sub axial cervical spine fractures managed with combined anterior and posterior spinal fusion. Overview of Literature: AO Type-B sub axial Cervical fractures involve disruption of the anterior column and posterior tension band osteoligamentous complex. Such injuries demand early surgical management with effective reduction and fusion of the involved vertebra. Though different methods of
reduction and surgical approaches have been published in the literature, we preferred global stabilization and fusion and evaluated their long-term outcome. Methods: We retrospectively evaluated 22 patients with post-traumatic unstable sub axial cervical spine injuries which got treated from 2006-2008 with their preoperative clinical details, radiographs, computed tomography, and magnetic resonance imaging of the cervical spine. All patients were managed by
immediate reduction, posterior and anterior stabilization, and fusion in a single session of anesthesia. Data of all patients were analyzed with respect to the status of fusion, pre-and post-operative neurological status based on Frenkel staging, along with their complications. Results: The mean age of the included patients was 32.9±12.14 years, with M:F ratio of 21:1. The average length of hospitalization was 20±12.63 days. All patients achieved fusion at a mean period of
4±1.45 months. Among the included 22 patients, only 68.18% (n=15) patients improved from their preoperative stage whereas the remaining 7 patients did not show any significant improvement in their clinical-grade since injury despite achieving solid fusion at the operated levels at a mean follow-up period of 15.42±1.43 years. No major complications were noted in the included patients. None of the
patients showed deterioration in their clinical-grade although 2 patients died in the follow-up period. Conclusions: In AO type-B sub axial cervical injuries, global stabilization and fusion in a single sitting is a viable option in surgical management without major complications. Although the procedure achieves fusion at the intended level, it does not guarantee neurological recovery.