Feasibility of single-stage combined anterior and posterior approach for fixation of highly unstable subaxial cervical spine trauma: A single surgeon case series

Even though anterior cervical discectomy and fusion (ACDF) allows for fixation of most subaxial cervical spine traumas, some highly unstable cases warrant circumferential fusion. We present our initial clinical experience of single-stage anterior and posterior cervical fixation over a 2-years period, for a total of 5 male patients (median age 55 [54–77]), among whom 4 high-kinetic trauma and one ballistic spine injury. Before surgery, there was one case of nerve root palsy, one incomplete spinal cord injury (SCI), and one complete SCI. Regarding anterior fixation, four patients underwent ACDF (median 70 [50–85] min) and one corpectomy (153 min). Patient positioning switch took a median of 55 (35–60) min. Regarding posterior fixation, three patients underwent single-segment lateral mass screws (median 94 [85–102] min), and two underwent posterior cervicothoracic fixation with laminectomy (median 145 [130–160] min). Median blood loss was 300 mL (200–450 mL). Among the five patients, four were operated on after hours, among whom three during the dark night. Three patients with single-level cervical trauma were discharged home after a median of 7 (4–14) days, and two patients went to rehabilitation after a median of 21 (0) days. The post-operative course was systematically uneventful surgically speaking. After a median follow-up of 12 (6–18) months, there was complete motor neurological recovery in two cases and partial recovery in the case of ballistic injury. Functional outcome was good according to visual analog scale (median 1/10 [0–3]), neck disability index (median 6/100 [0–52], and down to 3/100 [0–10] excluding patient 5), return to work (median 6 [3–6] months for 3 patients), and resuming of physical activities (median 6 [3–6] months for four patients). Emergency circumferential fusion for highly unstable trauma of the subaxial cervical spine seems feasible and safe for selected cases and after discussion with the anesthetist.