When is the circumferential stabilization necessary for subaxial cervical fracture dislocations? The posterior ligament-
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ORIGINAL ARTICLE
When is the circumferential stabilization necessary for subaxial cervical fracture dislocations? The posterior ligament‑bone injury classification and severity score: a novel treatment algorithm Jun‑Song Yang1,2 · Peng Liu2 · Tuan‑Jiang Liu2 · Hai‑Ping Zhang2 · Zheng‑Ping Zhang2 · Liang Yan2 · Yuan Tuo2 · Hao Chen2 · Peng Zou2 · Qing‑Da Li2 · Yuan‑Ting Zhao2 · Ding‑Jun Hao1,2 Received: 8 April 2020 / Revised: 13 August 2020 / Accepted: 24 August 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
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 4; and consistency of the surgical strategy with the treatment algorithm based on the PLICS. The exclusion criteria were as follows: vertebral split or burst fracture or severe compression fracture (> 30%) treated by anterior corpectomy
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European Spine Journal Table 1 The score to assess severity of injury to the posterior element Classification
Scores
Intact of PLC Mild injury of PLC Moderate injury of PLC Severe injury of PLC
0 1 2 3
PLC posterior ligamentous complex Table 2 The score to assess severity of injury to the lateral element Scores Ligamentous structure Normal alignment of facet joints Subluxation Dislocation Bony structure Without lateral mass fracture Stable lateral mass fracture Unstable lateral mass fracture Extremely unstable lateral mass fracture
0 1 2 0 1 2 3
without posterior fixation; multiple-level SCI; presence of ankylosing spondylitis or congenital spinal stenosis; pathologic fractures caused by infection or neoplasm; and old SCI (> 3 weeks). According to inclusion and exclusion criteria, there are 456 patients with SCFDs treated in our center between January 2016 and January 2018 were pr
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