• Jun-Song Yang, Ji-Jun Liu, Peng Liu, Zhen-Xing Zhang, Tuan-Jiang Liu, Yuan Tuo, Liang Yan, Zheng-Ping Zhang, Hai-Ping Zhang, Hao Chen, and Ding-Jun Hao.
• Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, and Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China.
• World Neurosurg. 2020 Feb 1; 134: e243-e248.

BackgroundSelection of approach for subaxial cervical fracture-dislocation (SCFD) is controversial. The questions of whether a posterior ligamentous structure (PLS) can be functionally healed in patients with SCFD and how long this healing process takes are critical in these patients.MethodsThis study retrospectively enrolled 394 patients with SCFD who underwent anterior decompression, reduction, and fusion between January 2002 and December 2017. The definition of functional healing of PLS was based on evaluations of clinical function and radiographic stability of PLS.ResultsFollow-up was available for 354 patients (89.8%). The PLS of 339 cases was functionally healed at the first follow-up interval without any posterior surgical intervention. No hardware failure or progressive cervical kyphosis was observed at further follow-up. At 12 months postoperatively, interbody fusion was satisfactory. However, the other 15 patients experienced nonhealing PLS at 8 weeks postoperatively and developed cervical deformity at further follow-up. Five patients refused revision surgery; the other 10 patients obtained solid fusion after revision surgeries.ConclusionsAmong 354 patients with SCFD and treated by single anterior reduction and fixation, simple PLS injury without any bony instability at the posterior column of the cervical spine can be functionally healed in 95.8% of patients by external fixation for 8 weeks. Whether this finding is applicable to various types of SCFD should be verified in further prospective studies with larger samples.Copyright © 2019 Elsevier Inc. All rights reserved.

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