Concept for direct reduction of large-sized cervical tear-drop fractures through a single anterior approach with follow up of five cases

Abstract

Introduction

Unstable large sized tear-drop fractures of the cervical spine (LSTDF) are difficult fractures to operate and there is a lack of standard in treatment. This study introduces an innovative technique for direct tear-drop fragment osteosynthesis with anterior cervical discectomy and fusion (TDFO-ACDF) and retrospectively analyzes clinical and radiological outcomes in five patients.

Patients and methods

Through a standardized anterior approach, the tear-drop fragment was reduced anatomically, the lower endplate restored and stabilized with lag-screws. Additionally, in four of five cases an anterior cervical discectomy and fusion (ACDF) using iliac crest bone graft was performed in combination with a VECTRA plate (DePuy Synthes, Zuchwil, Switzerland). X-ray check-up and functional outcome (neck disability index, NDI) was assessed during regular outpatient visits for at least two years postoperative.

Results

From 2013 until 2021 we operated five patients with the above-mentioned injury. All patients were operated the day after the accident and were hospitalized for 4 to 7 days. None of them had any neurological failures and all of them showed full clinical and radiological recovery without any clinical impairments. Median NDI was 2% ranging from 0 to 4% after a median follow up of 39 months (range 29 to 119 months).

Conclusion

The presented concept for treating large-sized tear-drop fractures of the cervical spine is safe. Utilizing a standard anterior approach with fundamental fracture management principles, this method enables direct bone healing and provides excellent postoperative results.