Distraction extension injuries of the cervical spine

Twenty-four consecutive patients with cervical distraction extension injuri es were retrospectively reviewed to study the safety and efficacy of variou s treatment protocols in this type of cervical spine injury. Sixteen of 24 patients with cervical distraction extension injuries underwent surgical st abilization. All patients undergoing surgical stabilization were noted to h ave a stable fusion at their latest follow-up. There were three instances o f surgically related neurologic deterioration as a result of over-distracti on of the anterior column interspace at the time of graft placement. The ov erall mortality rate was 42% in this aged patient population. Anterior reco nstruction of the cervical spine with an anterior cervical graft and plate acting as a tension band is the ideal treatment method for stabilization of acute distraction extension injuries involving primarily the soft tissue s tructures (anterior longitudinal ligament and intervertebral disc). Type 2 injuries, depending on the degree of displacement and the adequacy of close d reduction, may need to be approached initially posteriorly to obtain adeq uate alignment, followed by an anterior reconstructive procedure. Great car e should be taken during anterior graft placement to avoid over-distraction of the spine. If nonsurgical intervention is selected, close regular radio graphic follow-up is necessary to detect early vertebral malalignment, whic h may predispose to spinal cord dysfunction. Older patients sustaining this injury have a high mortality rate.