الفهرس 
Acknowledgements
Classification of Lower Cervical Spine InjuriesOnly 14 pages are availabe for public view
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Abstract
This study was ultimately conducted to evaluate the efficacy of anterior only approach for treatment of traumatic sub-axial cervical spine instability. Patients who were included in the study were acute traumatic cases with sub-axial cervical spine injury presenting to the Trauma Unit of Assiut University Hospital. The main treatment objectives of cervical spine traumatic injuries are decompression of nervous structures and stabilization of the injured vertebral segment. The options of surgical approach for unilateral or bilateral facet injuries include a stand-alone anterior approach, a stand-alone posterior approach, a combined anterior and posterior approach, or a staged anterior/posterior/anterior approach. Anterior approach has the advantages of supine position, less surgical trauma, less operative time and direct anterior decompression of neural elements such as a disc herniation or an anterior located bone fragment. The different types of complications that can result from an anterior approach to the cervical spine include vascular, esophageal, and tracheal damage, infection, injury to the recurrent laryngeal nerve and difficulty in achieving facet reduction in some cases. The most common complication is postoperative dysphagia which is related to manipulation and retraction of the esophagus during operative dissection. The primary determinants of efficacy of this study are radiographic measurements including local segmental angle, Ishihara curvature index, cervical lordosis angle and step off distance. Statistically significant differences in these primary outcome measures between preoperative and postoperative radiographs were established; however, the normal anatomical values were not achieved. A number of secondary outcome measures were used including self-reported measures (such as: neck disability index, visual analogue scale and the period required for returning to work) as well as comparison between neurological state preoperative and postoperative. The values of the self-reported measures revealed good patients’ satisfaction. Surgical treatment of lower cervical traumatic instability by means of anterior decompression and fusion is efficient regarding fusion state and the patients’ satisfaction; also, the anterior procedure takes short time and appears to be less traumatic to patients. However, the angle of the injured segment doesn’t return to its normal lordosis, and the full reduction was not achieved. Consequently, we recommend the anterior approach alone in cases with neurological impairment and in patients with medical co-morbidities or when a short operative time is preferred.