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The Advantages of Early Spine Fusion in the Treatment of Fracture-Dislocation of the Cervical Spine.

Forsyth, H. Francis; Alexander, Eben Jr.; Davis, Courtland Jr.; Underdal, Robert
Journal of Bone & Joint Surgery - American Volume: January 1959
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This Paper is concerned with the advantages of internal fixation and spine fusion early in the treatment of fracture-dislocations of the cervical spine. It is based on a statistical analysis of eighty-four cases of this entity treated within the clinical experience of the authors. It is important to understand the mechanism of injury in each case in order to treat it intelligently.

In the treatment of cervical-spine injuries, first consideration must be given to protection of the neural elements. Relieving all pressure from the spinal cord and nerve roots, and putting them at rest, affords the best opportunity for return of function of the neural elenments. To do this with certainty requires accurate reduction of bone elements, followed by internal fixation for immediate stability and spine fusion to prevent late recurrence. The general routine of skeletal traction, internal fixation, and spine fusion constitutes a method of treatment that needs to be varied but slightly in order to include a large percentage of all serious injuries of the cervical spine.

The results in thirty-eight spine fusions and forty-six injuries treated conservatively indicate that the patients in whom fusion was done had less residual deformity and a lower rate of recurrence. In addition less time was spent in the hospital or in uncomfortable casts, and less time was spent away from work.

The mechanism of injury in cervical-spine fractures and dislocations is discussed in some detail, with emphasis on the hyperextension types. A new interpretation of the roentgenographic findings in a large group of fracture-dislocations with mild anterior displacement shows that approximately half of them were caused by hyperextension rather than flexion as previously thought. Prior to the recognition of this mechanism, it was difficult to understand the severe neurological changes that were frequently present. Placing these cases in the group of hyperextension injuries makes the neurological damage understandable.

Copyright 1959 by The Journal of Bone and Joint Surgery, Incorporated

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