European Spine Journal

, Volume 19, Supplement 1, pp 33–39

Surgical treatment of upper, middle and lower cervical injuries and non-unions by anterior procedures

Review Article


The goals of any treatment of cervical spine injuries are: return to maximum functional ability, minimum of residual pain, decrease of any neurological deficit, minimum of residual deformity and prevention of further disability. The advantages of surgical treatment are the ability to reach optimal reduction, immediate stability, direct decompression of the cord and the exiting roots, the need for only minimum external fixation, the possibility for early mobilisation and clearly decreased nursing problems. There are some reasons why those goals can be reached better by anterior surgery. Usually the bony compression of the cord and roots comes from the front therefore anterior decompression is usually the procedure of choice. Also, the anterior stabilisation with a plate is usually simpler than a posterior instrumentation. It needs to be stressed that closed reduction by traction can align the fractured spine and indirectly decompress the neural structures in about 70%. The necessary weight is 2.5 kg per level of injury. In the upper cervical spine, the odontoid fracture type 2 is an indication for anterior surgery by direct screw fixation. Joint C1/C2 dislocations or fractures or certain odontoid fractures can be treated with a fusion of the C1/C2 joint by anterior transarticular screw fixation. In the lower and middle cervical spine, anterior plating combined with iliac crest or fibular strut graft is the procedure of choice, however, a solid graft can also be replaced by filled solid or expandable vertebral cages. The complication of this surgery is low, when properly executed and anterior surgery may only be contra-indicated in case of a significant lesion or locked joints.


Cervical spine Fracture-dislocation Anterior surgery Upper cervical spine Lower cervical spine 


  1. 1.
    Aebi M, Mohler J, Zäch G et al (1986) Indication, surgical technique, and results of 100 surgically-treated fractures and fracture-dislocations of the cervical spine. Clin Orthop Relat Res 203:244–257PubMedGoogle Scholar
  2. 2.
    Aebi M, Etter C, Coscia M (1989) Fractures of the odontoid process. Treatment with anterior screw fixation. Spine 14:1065–1070CrossRefPubMedGoogle Scholar
  3. 3.
    Aebi M, Webb J (1991) The spine. In: Müller ME (ed) Manual of internal fixation, 3rd edn. Springer, BerlinGoogle Scholar
  4. 4.
    Aebi M, Arlet V, Webb J (2007) AO spine manual, vol 1, Thieme PublishersGoogle Scholar
  5. 5.
    Aebi M, Zuber K, Marchesi D (1991) The treatment of cervical spine injuries by anterior or plating. Spine 16:38–45CrossRefGoogle Scholar
  6. 6.
    Bailey RW, Badgley GE (1960) Stabilization of the cervical spine by anterior fusion. J Bone Joint Surg A 42:565–594Google Scholar
  7. 7.
    Böhler J, Gaudernak T (1980) Anterior plate stabilization for fracture dislocation of the lower cervical spine. J Trauma 20:203–205PubMedGoogle Scholar
  8. 8.
    Bombart M, Roy Camille R, Castaing J, Derlon JY, Galibert P, Louis R, Saillant G, Sénégas J (1984) Recent injuries of the lower cervical spine. Rev Chir Orthop Reparatrice Appar Mot 70(7):501–559PubMedGoogle Scholar
  9. 9.
    Cloward RB (1961) Treatment of acute fractures and fracture-dislocations of the cervical Spine by vertebral-body fusion: a report of eleven cases. J Neurosurg 18:201–209CrossRefPubMedGoogle Scholar
  10. 10.
    Etter C, Coscia M, Jaberg H et al (1991) Direct anterior fixation of dens fractures with a cannulated screw system. Spine 16(3 Suppl):S25–S32PubMedGoogle Scholar
  11. 11.
    Geisler FH, Dorsey FC, Coleman WP (1991) Recovery of motor function after spinal cord injury: a randomized, placebo-controlled trial with GM-1 ganglioside. N Engl J Med 324(26):1829–1838PubMedCrossRefGoogle Scholar
  12. 12.
    Orozco Delcos R, Deldos R, Llovet TJ (1970) Osteosysthesis en las fracturas de raguis cervical: nota de technica. Rev Ortop Traumatol 14:285–288Google Scholar
  13. 13.
    Pointillart V, Orta AL, Freitas J, Vital JM, Sénégas J et al (1994) Odontoid fractures: review of 150 cases and practical application for treatment. Eur Spine J 3(5):282–285CrossRefPubMedGoogle Scholar
  14. 14.
    Reindl R, Sen MK, Aebi M (2003) Anterior Instrumentation for traumatic C1-C2 instability. Spine 28(17):E329–E333CrossRefPubMedGoogle Scholar
  15. 15.
    Reindl R, Quellet J, Harvey E et al (2006) Anterior reduction for cervical spine dislocation. Spine 12(6):648–652CrossRefGoogle Scholar
  16. 16.
    Ruf M, Melcher R, Harms J (2004) Transoral reduction and osteosynthesis C1 as a function preserving option in the treatment of unstable Jefferson fractures. Spine 29(7):823–827CrossRefPubMedGoogle Scholar
  17. 17.
    Schaeren S et al (2007) Upper cervical spine injuries. In: Aebi M et al (eds) AO spine manual clinical applications, vol 2. Thieme Stuttgart, New York, pp 85–115Google Scholar
  18. 18.
    Sen MK, Steffen T, Bechman L et al (2005) Atlanto-axial fusion using anterior transarticular screw fixation of C1/C2; technical innovation and biomechanical study. Eur Spine J 14(5):512–518CrossRefPubMedGoogle Scholar
  19. 19.
    Sénégas J, Gauzière JM (1976) In defence of anterior surgery in the treatment of serious injuries to the last 5 cervical vertebra. Rev Chir Orthop Reparatrice Appar Mot 62(2 suppl):123–128PubMedGoogle Scholar
  20. 20.
    Smith EW (1958) The treatment of certain cervical spine disorders by anterior removal of the intervertebral disc and interbody fusion. J Bone Joint Surg 40A(3):607–624Google Scholar
  21. 21.
    Verbiest H (1969) Anterior-lateral operations for fractures and dislocations in the middle and lower parts of the cervical spine: report of a series of forty-seven cases. J Bone Joint Surg A 51(8):1489–1530Google Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  1. 1.MEM Research Center for Orthopaedic Surgery, Institute for Evaluative Research in Orthopaedic SurgeryUniversity of BerneBernSwitzerland

Personalised recommendations