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Year : 2021  |  Volume : 8  |  Issue : 4  |  Page : 15-19

Post-Traumatic Cervicothoracic Junction Fracture–Dislocations: Technical Considerations and Outcome Analysis

Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India

Correspondence Address:
Sachin A Borkar
Department of Neurosurgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/joss.joss_15_21

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Aim: This study aimed to evaluate the factors determining the outcome after surgical management of C7–D1 fracture–dislocation and compare the various surgical approaches. Materials and Methodology: Retrospective analysis of 41 patients operated on for C7–D1 fracture–dislocation between 2015 and 2019 is assessed for the outcome. The data about preoperative clinicoradiological parameters and the surgical approach were collected and correlated with the outcome 1 week after surgery and final follow-up. Results: Forty-one patients were operated on for cervicothoracic junction (CTJ) fracture–dislocation during the study period. Out of these, 33 patients were treated via the anterior-only approach, while 4 were treated using the posterior-only and combined approach. Patients with American Spinal Injury Association (ASIA)-B score were found to have significant improvement as opposed to those with ASIA-A score at 1 week after surgery (54% vs. 10%, P = 0.005), at discharge (72.7% vs. 16%, P = 0.002), and at final follow-up (43.5% vs. 91%, P = 0.01). Pneumonia was the most common complication in the postoperative period developing in 36.5% of the patients. Other complications were sepsis (19.5%), bedsores (12.1%), and inhospital mortality (12.1%). Conclusions: CTJ is a notorious area for surgical management due to its unique biomechanical properties. The surgical approach should be customized according to the individual patient profile for optimum results in the postoperative period. CTJ injuries can be surgically managed with anterior, posterior, or combined approaches. Preoperative ASIA score can act as a valuable predictor of postoperative outcome in patients with CTJ injuries.

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