METHODS: Forty-seven consecutive patients with traumatic subaxial cervical spine instability were included in this study. All were classified in five groups according to our classification system describing both the mechanism and pathology of the instability. The type of the surgical approach, anterior, posterior or combined, was chosen according to this classification system. A total of 37 anterior, 4 posterior and 6 combined surgeries were performed. The neurological status of the patients was classified according to the Benzel-Larson grading system. Follow-up evaluation included re-grading of the patients' neurological status and also radiographic analyses with plain and dynamic roentgenograms and computerized tomography scans to assess the fusion rate in the late postoperative period.

RESULTS: Fusion was achieved in 38 of 40 patients (95%). Seven patients with total loss of muscle function below the injured level died because of cardiovascular instability and respiratory insufficiency. These patients were not included in the fusion study. The number of patients who had incomplete neurological deficit before surgery and became ambulatory with or without assistance at the late postoperative period was 28 (59.5%). The complications encountered were: two cases of neurological deterioration (all radicular in nature), two cases of pseudarthrosis, one esophagus fistula, six cases of malposition of anterior cervical plate (during the application) and two cases with adjacent level pathology.

CONCLUSION: Our classification system describing both the pathology and the mechanism of the injury is a simple and effective guide for the selection of the surgical approach in the treatment of patients with unstable cervical spinal injury. Keywords : Cervical trauma, stabilization, subaxial cervical injury