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When is the circumferential stabilization necessary for subaxial cervical fracture dislocations? The posterior ligament-bone injury classification and severity score: a novel treatment algorithm

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Abstract

Objective

To propose a novel classification and scoring system called the posterior ligament-bone injury classification and severity score (PLICS) that offers a quantitative score to guide the need for posterior stabilization in addition to anterior reconstruction for subaxial cervical fracture dislocations (SCFDs).

Methods

A total of 456 patients with SCFDs were prospectively included. Patients with PLICS ≥ 7 together with extremely unstable lateral mass fracture (EULMF) were classified as high-risk group, and the other patients were classified as low-risk group. For patients in the low-risk group, anterior-only reconstruction was performed; for patients in the high-risk group, additional posterior lateral mass fixation and fusion was performed after anterior reconstruction. Clinical outcome evaluation included using the visual analogue score (VAS), the Neck Disability Index (NDI), and the American Spinal Injury Association (ASIA) impairment scale. The change in the local sagittal alignment kyphosis Cobb angle was also recorded.

Results

A total of 370 patients (81.1%) completed the minimal 12-month follow-ups, including 321 patients of low-risk group and 49 patients of high-risk group. Compared with the average VAS score preoperatively, the score at 12-month follow-up was significantly improved (from 6.1 + 0.3 to 1.1 + 0.2 in the low-risk group, P < 0.001; from 6.4 + 0.2 to 1.4 + 0.2 in the high-risk group, P < 0.001). The average NDI score at the 12-month follow-up was statistically low in the low-risk group (8.8 + 2.5 vs 13.8 + 3.4, P = 0.034). At least more than one grade improvement in the ASIA scale was observed in 80.5% of all patients. The local kyphosis Cobb angle at the injured segment averaged improved in both groups.

Conclusion

A PLICS score ≥ 7 together with EULMF can be the threshold for posterior stabilization in addition to anterior reconstruction for the patients with SCFDs.

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Funding

We thank Chinese national natural science foundation (No. 81830077 for Ding-Jun Hao) for providing the grant.

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Authors and Affiliations

  1. Department of Orthopedics, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, 710054, China

    Jun-Song Yang & Ding-Jun Hao

  2. Department of Spine Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi, 710054, China

    Jun-Song Yang, Peng Liu, Tuan-Jiang Liu, Hai-Ping Zhang, Zheng-Ping Zhang, Liang Yan, Yuan Tuo, Hao Chen, Peng Zou, Qing-Da Li, Yuan-Ting Zhao & Ding-Jun Hao

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  1. Jun-Song Yang
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Contributions

Tuan-Jiang Liu, Jun-Song Yang and Ding-Jun Hao conceived the study design. Peng Liu, Hai-Ping Zhang, Yuan Tuo, Hao Chen, Peng Zou, Liang Yan, Zheng-Ping Zhang, Qing-Da Li and Yuan-Ting Zhao supervised the data collection and analysis. Jun-Song Yang drafted the manuscript. Ding-Jun Hao contributed to the revision. Ding-Jun Hao is responsible for this article.

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Correspondence to Ding-Jun Hao.

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Yang, JS., Liu, P., Liu, TJ. et al. When is the circumferential stabilization necessary for subaxial cervical fracture dislocations? The posterior ligament-bone injury classification and severity score: a novel treatment algorithm. Eur Spine J 30, 524–533 (2021). https://doi.org/10.1007/s00586-020-06580-8

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