Neurological outcome and postoperative stability after anterior cervical spine fixation by the use of cervical spine locking plate


  • Ch Ali Manzoor Department of Neurosurgery, Nishtar Hospital, Multan, Pakistan
  • Muhammad Irshad Department of Neurosurgery, Nishtar Hospital, Multan, Pakistan
  • Muhammad Aamir Department of Neurosurgery, Nishtar Hospital, Multan, Pakistan



Anterior fixation, Cervical spine, Cervical spine locking plate, Sub axial cervical spine injuries


Background: The fractures of cervical spine are divided into upper cervical spine (C1-C2) and lower cervical spine (C3-C7) also called sub axial cervical spine. Sub axial cervical injuries are common, ranging in severity from minor ligamentous strain or spinous process fracture to complete fracture dislocation with bone and ligament disruption, resulting in severe spinal cord injury. The objective of this study was to determine the neurological outcome and postoperative stability after anterior cervical spine fixation by the use of cervical spine locking plate (CSLP) attached with cancellous screws.

Methods: This descriptive study was carried out in the Department of Neurosurgery, Nishtar Hospital, Multan, Pakistan. One hundred and fifteen patients fulfilled the inclusion criteria were selected. Patient of either gender more than 15 years of age and less than 60 years of age having unstable lower cervical spine injuries from C-3 to C 7 on X-ray underwent anterior cervical fixation.

Results: Age range from 15 to 60 years with mean 32.34±standard deviation (SD) =12.06. The mean Frankel grading of the patients was 3.26±standard deviation (SD) =1.33. There were 97 (84.3%) male patients and 18 (15.7%) female patients. The neurological outcome was good in 107(89.6%) patients and poor in 12 (10.4%). The postoperative stability was YES in 109 (94.8%) patients and NO in 06 (5.2%). In the mode of injury there were 65 (56.5%) patients having road traffic accident, 41 (35.7%) patients having fall from tree/roof/stairs, 6 (65.2%) patients having fall of brick on the patient, 1 (0.9%) patient having Buffalo hit/animal contact, 2 (1.7%) patient having contact of head at floor of swimming pool after jumped in.

Conclusions: It is concluded from this study that good results were achieved with the use of the CSLP. The use of anterior approach in treatment of the injured lower spine is safe and effective.


Shaukat A, Ahmad G, Anjum MN. Cervical spine trauma x-ray interpretation pictorial review. Pak J Radiol. 2003;15:26-37.

Kwon BK, Vaccaro AR, Grauer JNM, Fisher CG, Dvorak MF. Sub axial cervical spine trauma. J Am Acad Orthop Surg. 2006;14:78-89.

Afridi HK, Khichi ZH, Aziz K. Medical and socioeconomic aspects of road traffic accidents. Ann King Edward Med Coll. 2006;12:310-11.

Bashir F, Malik A, Abaidullah S. Complications developed in spinal cord injured and physiotherapy. Ann King Edward Med Coll. 2001;7:61-3.

Leventhal MR. Fractures, dislocations, and fracture-dislocations of spine. In: Canale ST. Campbell’s operative orthopaedics. 10th ed. USA: Mosby; 2003:1597-1690.

Kocis J, Wends P, Visna P, Muzik V, Posa L. Injuries to the lower cervical spine. Acta Chr Orthop Traumatol Cech. 2004;71:366-72.

Bono CM. The halo fixator. J Am Acad Orthop Surg. 2007;15:728-37.

Kwon BK, Fisher CG, Boyd MC, Cobb J, Jebson H, Noonan V, et al. Prospective randomized controlled trial of anterior compared with posterior stabilization for unilateral facet injuries of the cervical spine. J Neurosurg Spine. 2007;7:1-12.

Stulik J, Krbec M, Vyskocil T. Injuries of the lower cervical vertebrae- the monocortical stabilization technique. Acta Chir Orthop Traumatol Cech. 2003;70:226-32.

Khan MB, Riaz M, Javed G, Hashmi FA, Sanaullah M, Ahmed SI. Surgical management of traumatic extra dural hematoma in children: Experiences and analysis from 24 consecutively treated patients in a developing country. Surgical Neurology International. 2013;4:103.

Zhang HO, Li KH, Long WR. Anterior approach in the surgical treatment of cervical fracture and spinal cord injury. Hunan Yi Ke Da Xue Xue Bao. 2002;27:139-42.






Original Research Articles