Introduction: The optimal surgical treatment for AO type A3 and A4 cervical spine fractures remains uncertain. Specifically, it is unclear whether anterior cervical corpectomy requires posterior fixation. This study aimed to investigate the clinical and radiological outcomes in cervical traumatic A3 and A4 patients treated by anterior and anterior plus posterior approach.
Methods: Subaxial cervical traumatic injuries were classified using the AO Spine Subaxial Injury Classification System. Patients were retrospectively divided into two surgical approach groups: anterior corpectomy alone (A) and anterior corpectomy with posterior fixation (Combined, A+P). Radiological parameters—including Cobb angle, segmental Cobb angle, upper instrumented vertebrae (UIV) collapse, and lower instrumented vertebrae (LIV) collapse—were measured postoperatively and at last follow-up (minimum three months apart) to assess kyphosis progression and vertebral collapse over time. Fusion was evaluated using the Brantigan score. Statistical analysis was performed using SPSS 25, with a p-value < 0.05 considered significant.
Results: From October 2015 to March 2024, 27 patients (21 A, 6 A+P) were included. Basic demographics—including age, gender, diabetes mellitus, hypertension, body mass index, corpectomy number, and operation time—were comparable between the two groups (p > 0.05). However, interbody graft types differed significantly (p = 0.04). There were no significant differences in Cobb angle change, segmental Cobb angle change, or UIV collapse between the two groups. However, LIV collapse was significantly higher in the anterior-only group (p < 0.05). Visual Analog Scale scores did not differ significantly (p=0.78). Fusion rates and implant failure proportions were also similar between groups (p=0.39 and 0.30, respectively), and no major complications were observed among all.
Conclusion : Combined anterior and posterior approach may prevent index vertebral collapse in patients with A3 and A4 subaxial cervical spine fractures, although it may not decrease non-union, implant failure or kyphosis development.
.jpg)
