Delayed Post-Traumatic Cervical Kyphosis Correction: An Institutional Experience.

Abstract

Objective: Post-traumatic cervical kyphosis is a frequently observed clinical entity in developing countries, secondary to inadequate imaging, socio-economic factors, and associated polytrauma injury. The primary objective is to highlight the clinical presentation and surgical outcomes based on clinical and functional parameters. The secondary objective is to highlight the role of traction and surgical intervention on the quality of life of these neglected patients.

Methods: Hospital records of 12 patients operated between 2008 and 2019 were retrospectively reviewed with a minimum follow-up of 24 months. Besides demographic information, radiological findings, and operative details, the outcome measures reported were neurological (ASIA score, MJOA), pain (VAS, NDI score), and operative complications.

Results: The cohort included neglected upper cervical injury (5 cases-Hangmen [3], odontoid [2]) and sub-axial injury (7 cases-unilateral [3]/bilateral [2] facet dislocation, teardrop [2] fracture) with a mean delay of 59.5 ± 6.7 days. The mean age of the cohort was 28.5 years with males (10) and females (2) (11-31 years). The major etiology included missed diagnosis (6 [inadequate imaging], associated injury [head injury: 4], and socio-economic factors [2]). Closed reduction by traction was achieved in four patients. Upper cervical injury reduction was achieved by posterior release, joint drilling, and Goel-Harms stabilization, whereas sub-axial injuries were approached by posterior release, reduction facetectomy ± anterior stabilization. Significant kyphotic deformity correction was noted (pre vs. post: 28.8 vs. 6.2, P < 0.05) and consequently, clinical improvement was noted in VAS (pre vs. post: 6.8 vs. 1.0, P < 0.05), NDI score (pre vs. post: 49.5 vs. 23.7, P < 0.05), MJOA (pre vs. post: 9.1 vs. 13.6 P < 0.05) ASIA score (mean grade + 1 improvement in all). Early complications included blood loss (upper cervical vs. sub-axial-512 mL vs. 392 mL [mean]) and late complications included junctional kyphosis (2).

Conclusions: A kyphotic deformity correction, if attempted in neglected traumatic cervical injuries, is also associated with significant clinical, functional, and radiographic improved outcomes.