FUNCTIONAL OUTCOME OF ANTERIOR CERVICAL DECOMPRESSION AND FIXATION BY PLATE AND SCREWS WITH BONE GRAFT IN TRAUMATIC INCOMPLETE LOWER CERVICAL SPINAL INJURY

Dr. Anup Mostafa*, Dr. Md. Rayhan Ali Mollah, Dr. Md. Shafiul Ezaz, Dr. Shahidul Islam Chowdhury

ABSTRACT

Background: Acute injury to the lower cervical spine and spinal cord is one of the most common causes of severe disability and death after trauma. It is a devastating event on a personal and family level as well as tremendous financial burden to the society. To date, there is no clear consensus on the best treatment option for lower cervical fracture-dislocation. In recent years, anterior cervical decompression and fixation (ACDF) has been widely accepted. Through this study, we have assessed the functional outcome of ACDF. Objective: To observe the functional outcome of anterior cervical decompression and fixation by plate and screws with bone graft in traumatic incomplete lower cervical spinal injury. Materials and Methods: It is a prospective observational study which was performed in the Department of Orthopaedics, Dhaka Medical College Hospital (DMCH), Dhaka on 15 patients. Study period was 9 months. The primary purpose of this study was to observe the functional outcome of anterior cervical decompression and fixation (ACDF) by plate and screws with bone graft in traumatic incomplete lower cervical spinal injury. All patients with incomplete lower cervical spinal injuries attending in the Department of Orthopaedics, DMCH were included. Participants were selected by consecutive purposive sampling who met the selection criteria. Proper history was taken. Neuro-functional recovery of each patient was assessed by the American Spinal Injury Association (ASIA) impairment scale (AIS). Functional outcome was assessed using visual analog scale, Oswestry disability index and Macnab criteria. Bony fusion was determined by Bridwell fusion grading system. Results: The mean age was found 44.53±12.51 years with male dominancy (86.7%). Most of them are farmers (46.70%) and the most common cause is fall from height (46%). The most commonly affected level is C 5/6 (60%). Post-operatively on final follow up, ASIA grade improvement was two grade shifts in 20%, one grade shift in 66.7% and no shift in 13.7%. Minimum disability according to the Oswestry disability index, and mild pain according to visual analog scale was found at the final follow up. According to Bridwell fusion grading system, grade-I bony fusion was seen in 80% of cases. Conclusion: Anterior decompression, stabilization and fusion by cervical plate and screws with bone graft is an effective method which provides considerable benefit in the form of significant improvement of neurological outcome as well as yields good functional outcome.

Keywords: Lower cervical spine, spinal cord, anterior cervical decompression.