REVIEW

Surgical Techniques, Materials, and Outcomes in Vertebral Fixation of Cervical Trauma

Técnicas Cirúrgicas, Materiais e Resultados na Fixação Vertebral de Trauma Cervical

  • João Alfredo Schiewe    João Alfredo Schiewe
  • Igor Antonio Tinti    Igor Antonio Tinti
  • Vinicius Aguiar Bellon    Vinicius Aguiar Bellon
  • Daniel Rodrigo Serbena    Daniel Rodrigo Serbena
  • Ivo Ilvan Kerppers    Ivo Ilvan Kerppers
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  Downloads: 3

Resumo

O presente estudo analisa os desfechos clínicos e as complicações associadas, com o objetivo de avaliar os resultados da fixação cervical em casos de trauma, com ênfase nos tipos de enxertos e suas complicações. Uma revisão sistemática de nove estudos envolvendo 279 pacientes foi conduzida, analisando as técnicas cirúrgicas, materiais e efeitos adversos. As cages de titânio apresentaram menores índices de complicações (16,26%) em comparação com os enxertos tradicionais (54,84%). Técnicas avançadas, como cirurgia robótica assistida, apresentaram redução do tempo de operação e da perda de sangue. As cages de titânio se mostraram eficazes na redução de complicações e na melhora dos resultados. Estudos futuros devem investigar resultados a longo prazo e os aspectos econômicos para orientar práticas clínicas baseadas em evidências.

Palavras-chave

Trauma cervical; Fixação espinhal; Técnicas cirúrgicas; Enxertos ósseos; Desfechos clínicos

Abstract

This study analyzes clinical outcomes and associated complications, aiming to assess the results of cervical fixation surgeries in trauma cases, with a focus on graft types and complications. A systematic review of nine studies involving 279 patients was conducted, analyzing surgical techniques, materials, and adverse events. Titanium cages showed lower complication rates (16.26%) compared to traditional grafts (54.84%). Advanced techniques, such as robotic-assisted surgery, reduced operative time and blood loss. Titanium cages proved effective in reducing complications and improving outcomes. Future studies should investigate long-term results and economic aspects to guide evidence-based clinical practices.

Keywords

Cervical trauma; Spinal fixation; Surgical techniques; Bone grafts; Clinical outcomes

References

1. van Den Hauwe L, Sundgren PC, Flanders AE. Spinal trauma and spinal cord injury (sci). In: Hodler J, Kubik-Huch R, von Schulthess G. Diseases of the brain, head and neck, spine 2020–2023. Cham: Springer; 2020. p. 231-40. https://doi.org/10.1007/978-3-030-38490-6_19.

2. Deabes AM, Elmeleigy SA, Osman MS. An analysis of predicting factors for surgical outcomes in traumatic cervical spine subluxation operated with cages and plates. Benha Med J. 2023;0(0):0. https:// doi.org/10.21608/bmfj.2023.212842.1827.

3. Subramaniam MH, Venkatesan M, Hegde SK. Clinicoradiological outcome of 3 or more levels of anterior cervical corpectomy and reconstruction. Int J Spine Surg. 2021;15(4):740-51. https:// doi.org/10.14444/8096. PMid:34315759.

4. Phan K, Pelletier MH, Rao PJ, Choy WJ, Walsh WR, Mobbs RJ. Integral fixation Titanium/Polyetheretherketone cages for cervical arthrodesis: evolution of cage design and early radiological outcomes and fusion rates. Orthop Surg. 2019;11(1):52-9. https://doi.org/10.1111/ os.12413. PMid:30614216.

5. Zaïri F, Aboukais R, Thines L, Allaoui M, Assaker R. Relevance of expandable titanium cage for the treatment of cervical spondylotic myelopathy. Eur Spine J. 2012;21(8):1545-50. https://doi.org/10.1007/ s00586-012-2380-2. PMid:22639300.

6. Ahn JS, Lee JK, Kim JH. Comparative study of clinical outcomes of anterior cervical discectomy and fusion using autobone graft or cage with bone substitute. Asian Spine J. 2011;5(3):169-175. https:// doi.org/10.4184/asj.2011.5.3.169. PMid:21892389.

7. Turel MK, Kerolus MG, Traynelis VC. Machined cervical interfacet allograft spacers for the management of atlantoaxial instability. J Craniovertebr Junction Spine. 2017;8(4):332-7. https://doi.org/10.4103/ jcvjs.JCVJS_87_17. PMid:29403245.

8. Kobayashi L, Coimbra R, Goes AMO Jr, et al. American Association for the Surgery of Trauma–World Society of Emergency Surgery guidelines on diagnosis and management of peripheral vascular injuries. J Trauma Acute Care Surg. 2020;89(6):1183-96. https://doi.org/10.1097/TA.0000000000002967. PMid:33230048.

9. Tang Y, Li H, Zhang S, et al. Comparison of Anterior Cervical Discectomy Fusion Combined with Lateral Mass Screw and with Cervical Pedicle Screw Fixation Surgery under O-Arm Navigation for Single-Stage Management of Severe Lower Cervical Fracture Dislocation. Orthop Surg. 2023;15(10):2647-55. https://doi.org/10.1111/os.13868. PMid:37652712.

10. Lee HQ, Kow CY, Ng JS, et al. Correlation of Anterior Interbody Graft Choice With Patient-Reported Outcomes in Cervical Spine Trauma. Global Spine J. 2019;9(7):735-42. https:// doi.org/10.1177/2192568219828720. PMid:31552155.

11. Vaccaro AR, Fisher CG. Evidence-based Recommendations for Spine Surgery. Spine. 2022;47(13):965-6. https://doi.org/10.1097/ BRS.0000000000004363. PMid:35802122.

12. Higgins J, Thomas J, Chandler J, et al, editors. Cochrane handbook for systematic reviews of interventions. 2nd ed. Hoboken: John Wiley & Sons; 2019. https://doi.org/10.1002/9781119536604.

13. Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71. https://doi.org/10.1136/bmj.n71.

PMid:33782057.

14. Sterne JA, Hernán MA, Reeves BC, et al. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ. 2016;355:i4919. https://doi.org/10.1136/bmj.i4919. PMid:27733354.

15. Brockmeyer D, Apfelbaum R, Tippets R, Walker M, Carey L. Pediatric cervical spine instrumentation using screw fixation. Pediatr Neurosurg. 1995;22(3):147-57. https://doi.org/10.1159/000120893. PMid:7786808.

16. Frangen TM, Zilkens C, Muhr G, Schinkel C. Odontoid fractures in the elderly: dorsal C1/C2 fusion is superior to halo-vest immobilization. J Trauma. 2007;63(1):83-9. https://doi.org/10.1097/ TA.0b013e318060d2b9. PMid:17622873.

17. Jun XH, Yi L. Percutaneous fixation of Levine-Edwards Type II hangman’s fractures under the guidance of an orthopedic robot. Orthopedics. 2023;46(1):59-63. https://doi.org/10.3928/0147744720221031-08. PMid:36343643.

18. Kanna RM, Shetty AP, Rajasekaran S. Modified anterior-only reduction and fixation for traumatic cervical facet dislocation (AO type C injuries). Eur Spine J. 2018;27(6):1447-53. https://doi.org/10.1007/ s00586-017-5430-y. PMid:29279998.

19. Lang S, Neumann C, Fiedler L, Alt V, Loibl M, Kerschbaum M. Does dynamic anterior plate fixation provide adequate stability for traumatic subaxial cervical spine fractures at mid-term follow-up? J Clin Med. 2021;10(6):1-11. https://doi.org/10.3390/jcm10061185. PMid:33809041.

20. Ramnarain A, Govender S. Fibular allograft and anterior plating for dislocations/fractures of the cervical spine. Indian J Orthop. 2008;42(1):83-6. https://doi.org/10.4103/0019-5413.38587. PMid:19823661.

21. Jain V, Thakur MK, Thakur A, Sud S, Lal M, Madan A. Functional outcome in unstable Hangman’s fracture managed with anterior approach: A prospective study. J Craniovertebr Junction Spine. 2017;8(4):350-3. https://doi.org/10.4103/jcvjs.JCVJS_113_17. PMid:29403248.

22. Payer M. Implantation of a distractible titanium cage after cervical corpectomy: technical experience in 20 consecutive cases. Acta Neurochir (Wien). 2006;148(11):1173-80, discussion 1180. https://doi.org/10.1007/ s00701-006-0871-9. PMid:16927030.



1Neuroanatomy and Neurophysiology Laboratory, Universidade Estadual do Centro-Oeste – UNICENTRO, Guarapuava, PR, Brasil.

 

Received Aug 20, 2025

Accepted Sep 7, 2025


JBNC  Brazilian Journal of Neurosurgery

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