Pour évaluer l’évolution radiologique des arthrodèses cervicales par cage radio-transparente et plaques antérieures, nous avons revu les blessés pris en en charge entre octobre 1999 et juin 2003 pour traumatisme du rachis cervical sans lésion neurologique médullaire.

Notre série comportait 30 patients et 32 arthrodèses. Les lésions se répartissaient en : 1 tear Drop, 8 entorses graves en flexion, 4 luxations bi-articulaires, 4 entorses graves en hyperextension, 1 luxation-fracture, 7 fractures uni-articulaires, 4 fractures-séparations du massif articulaire, 3 hernies post-traumatiques. Nous avons pris en compte l’angle inter-somatique, le déplacement antérieur ainsi que la hauteur au milieu du disque intervertébral.

La technique chirurgicale consistait en une arthrodèse intersomatique utilisant une cage remplie d’os spongieux associée à une plaque antérieure. Il a été associé 4 temps postérieurs.

Tous les malades ont étés revus au moins jusqu’à fusion intersomatique survenue en moyenne au 78^e jour.

L’angle intersomatique moyen est passé de 11,6° de cyphose à 13° de lordose. Le déplacement antérieur est passé de 3 mm à 0,3 mm. La hauteur de l’espace intersomatique est passée de 5,3 à 8,2 mm. Il n’a pas été observé de déplacement secondaire, ni de complications.

Cette étude montre que l’arthrodèse par cages associées à une ostéosynthèse antérieure peut être utilisée en traumatologie. Cette technique d’arthrodèse inter-somatique est simple, fiable et à faible morbidité pour les lésions traumatiques instables sans lésion neurologique médullaire. Elle permet une réduction quasi anatomique en un délai de fusion faible.

The purpose of this study was to determine whether spinal fusion using radiotransparent cages can be an appropriate treatment for traumatic injury of the cervical spine.

This series included 30 patients aged 17-84 years (average 46 years) treated between October 1999 and June 2003 for traumatic injury of the cervical spine without neurological deficit or cord injury. There were two bifocal cases so that the study concerned 32 fusions. Injuries were: tear drop (n=1), serious flexion sprain (n=8), biarticular dislocation (n=4), serous hyperextension sprain (n=4), dislocation-fracture (n=1), uniarticular fracture (n=7), fracture-separation of the facet joints (n=4), post-traumatic herniation (n=3). For each injury, we measured pre and postoperatively and at last follow-up: the intersomatic angle, anterior displacement, and height of the intersomatic space at the center of the intervertebral disc. All x-rays were read twice, by two independent investigators. In the event of disagreement, the x-rays were read again by a senior surgeon and the main author of this article.

Anterior fusion was achieved using a Poly Ether Ether Ketone (PEEK) (32%) and knitted carbon (68%) cage (cologne, Ostapek, Nexis) filled with cancellous bone harvested percutaneously from the iliac crest. The cage was associated with an anterior titanium plate fixation (Senegas, Euros and Orion, Medtronic). A posterior approach was associated if further stability was required (n=4 fusions).

All patients were reviewed at minimum five months follow-up. Intersomatic fusion was verified on the standard x-rays (plus stress images and computed tomography at three months). Fusion was considered to be achieved if continuous bone lines crossed the graft and angle measurements remained stable, with the cage in the same position on successive examinations.

One patient died from lung cancer five months after spinal fusion. All other patients survived with a mean follow-up of 24 months. Fusion was achieved in all cases, at mean 78 days. The mean intersomatic angle increased from 12° kyposis preoperatively to 13° lordosis postoperatively at last follow-up. Anterior displacement of the fractured vertebral body was 3 mm preoperatively and 0.3 mm postoperatively. Height in the middle of the intersomatic space was 5.3 mm preoperatively and 8.2 mm postoperatively. There were no cases of secondary displacement.

This study demonstrated that fusion with an intersomatic cage associated with anterior plating can be used in spine trauma victims, providing an outcome as good as in patients with degenerative disease. This method enables nearly anatomic reduction without secondary displacement and fusion in a short delay (which can be explained by the mechanical properties of the assembly and by the use of pure cancellous graft from the iliac crest). There is very little morbidity in our experience. For us, this technique is more reliable than fusion using a tri-cortical iliac crest graft.

The use of an intersomatic cage is a simple, reliable technique for intersomatic spinal fusion with little morbidity for unstable traumatic injury of the spine without spinal cord injury.