Circumferential fusion for sub-axial cervical spine fracture - subluxations

Fracture subluxation or traumatic spondylolisthesis of sub-axial cervical spine is a common but serious spinal injury encountered by neurosurgeons. It is frequently associated with spinal cord injury. Although decompression of spinal cord either anteriorly or posteriorly depending upon the site of compression is straight forward, there is no consensus regarding the approach for stabilization of spine either anterior or posterior or both, after decompression of spinal cord. Circumferential fusion involves combined anterior and posterior stabilization of sub-axial cervical spine. Some of the cases of circumferential fusion performed by the author are presented here. Anterior stabilization was performed with titanium cage or iliac graft insertion at corpectomy or discectomy site along with Anterior cervical plating and posterior stabilization was performed with Apofix clamps or interspinous wiring (cable) or lateral mass plating. Also one patient in whom only anterior stabilization was performed but who had recurrence of dislocation is also cited as an example of inadequacy of only one approach of stabilization to a 3 column cervical spine injury.