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Anterior Stabilization in Cervical Spine Fractures

Anterior Stabilization in Cervical Spine Fractures. A Dismal Image. Cord injury not treatable still Unpredictable outcome Prolonged course of treatment Psychosocial factors. Commonest and most devastating injury of axial skeleton. Spinal cord injuries.

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Anterior Stabilization in Cervical Spine Fractures

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  1. Anterior Stabilization in Cervical Spine Fractures

  2. A Dismal Image • Cord injury not treatable still • Unpredictable outcome • Prolonged course of treatment • Psychosocial factors Commonest and most devastating injury of axial skeleton

  3. Spinal cord injuries • Constitute 2-5 % of all blunt trauma • 40-50 cases / million • 40 % of cervical spine injuries have cord involvement • Cost factor

  4. Goals of treatment • To realign the spine • To prevent loss of function in uninjured neural tissue • To improve neurological recovery • To obtain early functional recovery • To obtain and maintain spinal stability

  5. Indications • Instability • Decompression • Stabilization • Anterior • posterior

  6. Instability • Loss of ability of the spine to maintain relation ship between vertebrae • White and Punjabi - 2 column concept • Dennis - 3 column concept • Radiological evidence • Translation 3.5 mm • Angulation 11 degrees • Widening of inter spinous distance

  7. Anterior Approach Advantages • Easy positioning • Easy removal of disc • Less invasive • Less chances for kyphosis or disc degeneration • Simple technique under direct vision • Enables compression of the graft • Rigid immobilization

  8. Anterior plating Disadvantages • Possibility of loosening • Chances of infection • Possibility of neurological injury • Chances of fistula formation • Not possible in unreduced facet dislocation

  9. Historical back ground • Considered in the past as a “disease not to be treated” • Crutchfield traction in 1933 • Halo vest Nickel and Perry 1950 • Operative stabilization Harda 1891 • Posterior plating-Roy-Camille 1964 • Anterior approach Cloward 1953

  10. Khoula experience

  11. Initial management steps • Haemodynamic stabilization • Cervical collar • X-ray • CT scan • MRI • Steroids

  12. Initial management steps • Traction • Secondary exam • ICU admission • Prevention of DVT • Physiotherapy

  13. Surgical Procedure

  14. Anatomy

  15. Types of plates

  16. A retrospective study32 cases

  17. Demographic pattern SEX AGE

  18. Cause of injury

  19. Level of injury

  20. Corpectomy13 Discectomy19

  21. Associated injuries

  22. Neurological StatusFrankel STATUS IMPROVEMENT

  23. Timing of surgery

  24. Complications related to surgery

  25. ComplicationsGeneral

  26. Case Illustrations

  27. Case2

  28. Case 3

  29. Case 4

  30. Case 5

  31. Case 6

  32. Case 7

  33. Case Illustration8.

  34. Case 9

  35. Summary & Conclusions • Anterior approach is better in our experience • Early surgical intervention improves out come • Delayed treatment is common in Oman • Reluctance in accepting surgical treatment

  36. Suggestions • Early detection and emergency treatment in the periphery • Early transfer • Better facilities at receiving end • Rehabilitation services • Team work

  37. THANK YOU

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