Progression of local kyphosis after conservative treatment for compressive cervical spine fracture with spinal cord injury

Kazuya Yokota, Takeshi Maeda, Osamu Kawano, Eiji Mori, Tsuneaki Takao, Hiroaki Sakai, Muneaki Masuda, Yuichiro Morishita, Tetsuo Hayashi, Kensuke Kubota, Yasuharu Nakashima

Research output: Contribution to journalArticle

Abstract

Introduction: Compressive-flexion type cervical spine fracture is typically accompanied by apparent dislocation of the facet joints, undesirable cervical alignment, and devastating neurological dysfunction, which provides strong rationale for rendering prompt operative treatment. However, the validity of conservative treatment for compressive-flexion cervical spine injury in cases with preserved congruity of the facet joints has yet to be elucidated. The purpose of this study is to evaluate the long-term outcome of cervical alignment following conservative treatment for compressive-flexion cervical spine injury with preserved congruity of the facet joints. Methods: A total of 662 patients who experienced spinal cord injury from 2007 to 2017 were included and underwent retrospective review in a single institute. Thirteen patients were identified as receiving conservative therapy following compressive-flexion cervical spine fractures with spinal cord injury. Clinical and radiological results were collected, including vertical fractures of the vertebral column, laminar fractures, progression of local kyphosis, and neurological status. The degree of the local cervical kyphosis was evaluated with two methods: the posterior tangent method and the endplate method. Results: All 13 patients were male, and the mean age at the time of injury was 28.4 years. The mean follow-up period was 3 years. Although none of the patients presented neurological deterioration after the injury, the degree of local kyphosis was increased at the time of final follow-up compared to what was observed at the time of injury. Patient age at the time of injury and concurrent vertical fracture of vertebral body could have been influencing factors for the progression of the kyphosis. While laminar fracture affected the kyphosis at the time of injury, it was not a strong influencing factor of the overall progression of local kyphosis. Conclusions: The conservative option for the compressive-flexion cervical injury allowed us to treat without exacerbating neurological symptoms as long as the facet joints are preserved. However, in terms of cervical alignment, surgical stabilization may have been desirable for these patients. Notably, the younger patients and the patients with vertical fracture of the cervical vertebral column in this type of injury required closer observation to help prevent the progression of local kyphosis.

Original languageEnglish
Article number98
JournalJournal of Orthopaedic Surgery and Research
Volume14
Issue number1
DOIs
Publication statusPublished - Apr 11 2019

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Kyphosis
Spinal Cord Injuries
Spine
Zygapophyseal Joint
Wounds and Injuries
Conservative Treatment
Observation

All Science Journal Classification (ASJC) codes

  • Surgery
  • Orthopedics and Sports Medicine

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Progression of local kyphosis after conservative treatment for compressive cervical spine fracture with spinal cord injury. / Yokota, Kazuya; Maeda, Takeshi; Kawano, Osamu; Mori, Eiji; Takao, Tsuneaki; Sakai, Hiroaki; Masuda, Muneaki; Morishita, Yuichiro; Hayashi, Tetsuo; Kubota, Kensuke; Nakashima, Yasuharu.

In: Journal of Orthopaedic Surgery and Research, Vol. 14, No. 1, 98, 11.04.2019.

Research output: Contribution to journalArticle

Yokota, Kazuya ; Maeda, Takeshi ; Kawano, Osamu ; Mori, Eiji ; Takao, Tsuneaki ; Sakai, Hiroaki ; Masuda, Muneaki ; Morishita, Yuichiro ; Hayashi, Tetsuo ; Kubota, Kensuke ; Nakashima, Yasuharu. / Progression of local kyphosis after conservative treatment for compressive cervical spine fracture with spinal cord injury. In: Journal of Orthopaedic Surgery and Research. 2019 ; Vol. 14, No. 1.
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AU - Yokota, Kazuya

AU - Maeda, Takeshi

AU - Kawano, Osamu

AU - Mori, Eiji

AU - Takao, Tsuneaki

AU - Sakai, Hiroaki

AU - Masuda, Muneaki

AU - Morishita, Yuichiro

AU - Hayashi, Tetsuo

AU - Kubota, Kensuke

AU - Nakashima, Yasuharu

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Y1 - 2019/4/11

N2 - Introduction: Compressive-flexion type cervical spine fracture is typically accompanied by apparent dislocation of the facet joints, undesirable cervical alignment, and devastating neurological dysfunction, which provides strong rationale for rendering prompt operative treatment. However, the validity of conservative treatment for compressive-flexion cervical spine injury in cases with preserved congruity of the facet joints has yet to be elucidated. The purpose of this study is to evaluate the long-term outcome of cervical alignment following conservative treatment for compressive-flexion cervical spine injury with preserved congruity of the facet joints. Methods: A total of 662 patients who experienced spinal cord injury from 2007 to 2017 were included and underwent retrospective review in a single institute. Thirteen patients were identified as receiving conservative therapy following compressive-flexion cervical spine fractures with spinal cord injury. Clinical and radiological results were collected, including vertical fractures of the vertebral column, laminar fractures, progression of local kyphosis, and neurological status. The degree of the local cervical kyphosis was evaluated with two methods: the posterior tangent method and the endplate method. Results: All 13 patients were male, and the mean age at the time of injury was 28.4 years. The mean follow-up period was 3 years. Although none of the patients presented neurological deterioration after the injury, the degree of local kyphosis was increased at the time of final follow-up compared to what was observed at the time of injury. Patient age at the time of injury and concurrent vertical fracture of vertebral body could have been influencing factors for the progression of the kyphosis. While laminar fracture affected the kyphosis at the time of injury, it was not a strong influencing factor of the overall progression of local kyphosis. Conclusions: The conservative option for the compressive-flexion cervical injury allowed us to treat without exacerbating neurological symptoms as long as the facet joints are preserved. However, in terms of cervical alignment, surgical stabilization may have been desirable for these patients. Notably, the younger patients and the patients with vertical fracture of the cervical vertebral column in this type of injury required closer observation to help prevent the progression of local kyphosis.

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