THE ROLE OF ANTERIOR SURGERY FOR VERTEBRAL FRACTURES WITH AND WITHOUTCORD COMPRESSION

The indications for anterior surgery are well defined in the upper and lower cervical spine if one accepts the importance of early restorati on of stability for improved patient rehabilitation. Cannulated screw fixation of Type II fractures of the odontoid peg is a highly speciali zed procedure that requires technical expertise still only available a t a limited number of orthopaedic centers. The engineering improvement s in internal fixation for the anterior cervical spine, allied with an increasing expertise in instrumentation, have increased the tendency toward anterior stabilization for all unstable lower cervical fracture s, except irreducible dislocations, irrespective of the mechanism of i njury. Most thoracolumbar fractures with less than 50% to 60% canal co mpromise can be adequately dealt with by posterior surgery, largely be cause of the powerful correction inherent in the short segment, pedicl e crew systems available. Anterior surgery continues to have a role in the correction of severe disruption, late deformity, and chronic ante rior cord compression. No ideal anterior internal fixation system exis ts, but the Kaneda device is undoubtedly the strongest. The timing and indications for intervention for acute cord compression remain contro versial in the absence of neurologic deterioration, although the route is undisputedly anterior in view of the usual site of compression.