A review of the therapeutic concept and results of operative treatment in acute and chronic lesions of the cervical spine: the Hannover experience.

Abstract

A therapeutic concept for the treatment of acute and chronic cervical spine lesions is presented. Unstable fractures and dislocations of the cervical spine should be reduced as soon as possible. Most frequently, we employ the anterior approach using the Smith and Robinson technique (37) with the addition of an H-shaped plate. The posterior approach is mainly indicated for the release of irreducible locked facets. Unstable odontoid fractures, especially those in group II of Anderson and d'Alonzo (3), are stabilized by screw osteosynthesis. Between 1971 and 1989, 306 patients with cervical spine lesions were treated surgically. In these cases, there were 205 acute injuries and 52 chronic instabilities. Forty-nine patients had tumors or metastases. Ninety-two patients with acute injuries (group I) and 24 with chronic lesions (group II) were reexamined. Out of 53 group I patients, the neurologic symptoms improved in 45 cases (85%), and in 30 of these (mainly with radicular compression syndromes) a complete recovery was noted. Seventy-two percent of the patients were symptom-free. Seventy-four percent of the acute and 58% of the chronic lesions showed a good or very good result having little or no limitation of motion and minimal or no pain. Irrespective of neurologic deficits, 89% of the acute traumatized patients were able to work after 5 months. The rate of pseudarthrosis was 2%. The risks of an anterior interbody arthrodesis are small when using a careful and standardized operative technique. It allows an early functional treatment and shortens the rehabilitation time.