Surgical Management of Traumatic Subaxial Cervical Spine Instability in Resource-constrained Environments

Introduction: Traumatic instability of the subaxial cervical spine presents significant challenges, particularly in resource-limited settings where access to advanced surgical tools and implants may be constrained. This study aims to evaluate the outcomes of managing cervical spine instability using a combination of interlaminar wiring via a posterior approach and the standard anterior cervical discectomy and fusion (ACDF) technique. These methods were applied to optimize stabilization and restore functional outcomes while adhering to ethical principles of equitable and sustainable healthcare.

Methods: The study included cases treated at Hospital San Juan de Dios, Bolivia, involving patients with subaxial cervical instability. Two primary techniques were utilized based on the patient’s specific condition and available resources: interlaminar wiring via a posterior approach to ensure stabilization in emergency scenarios and the standard ACDF technique for decompression and fusion in cases where sufficient resources were accessible. Patient demographics, neurological outcomes, and postoperative stability were documented.

Results: The use of interlaminar wiring provided adequate stabilization and pain relief in resource-limited settings, proving effective in maintaining alignment and enabling functional improvement. In patients where ACDF was feasible, more substantial decompression was achieved, offering superior neurological recovery, particularly in cases with preoperative neural deficits. Across both techniques, complications were minimal, and both methods facilitated satisfactory load-bearing capacity and correction of deformities. The application of interlaminar wiring allowed for safe and precise stabilization under restricted circumstances, reinforcing the value of adaptive surgical strategies.

Conclusion : This study underscores the viability of interlaminar wiring as a practical alternative in managing cervical instability when modern implants are unavailable, while also highlighting the advantages of ACDF in settings with more resources. These findings support the need for adaptable, resource-sensitive approaches in neurosurgical spine care, especially in emergency and low-resource contexts, aligning with ethical commitments to equitable healthcare provision.