Jan Rodemerk, Markus Pierscianek, Marvin Darkwah Oppong, Daniela Pierscianek, Philipp Dammann, Ulrich Sure, Karsten H. Wrede, Ramazan Jabbarli
Department of Neurosurgery, University Hospital Essen, Germany
DOI: 10.3205/21dgnc292
ABSTRACT
Introduction: Preoperative traction with the Gardner-Wells Tongs (PTGWT) is a valuable option for the cervical spine injuries with malalignment. The aim of this study was to analyze the factors related to the treatment success of PTGWT.
Methods: All consecutive cases with PTGWT due to cervical spine injury with malalignment treated in our hospital between January 2010 and September 2020 were eligible for the study. Patients’ records were reviewed for demographic and clinical characteristics. Treatment success was evaluated upon the angle correction in the sagittal plane using the computed tomography scans before and after completing the PTGWT. Statistical analysis was conducted using R version 3.6.0.
Results: Of 24 patients in the final analysis (mean age: 67.8±18.0 years; 13 females [54.17%]), 14 individuals were treated for the type II odontoid fracture, the remaining cases presented with luxation (n=5) or burst (n=5) fractures between C 3 and 7. There were no PTGWT-related complications and no incompliance cases in the series. Patients’ demographic characteristics and previous medical history, the time passed since the injury (p=0.59), as well as the duration of the PTGWT (p=0.76) were not associated with the correction of the deviation angle. The duration of PTGWT for the burst fractures was longer (5.0±3.7 days, p=0.02), as compared to the luxation (2.4±1.1 days) and odontoid (2.1±1.5 days) fractures. PTGWT resulted in a significant improvement of the angular deviation for the odontoid (13.1°±12.4°, p<0.01), but not for the luxation (8.0°±10.9°, p=0.17) and burst injuries (9.7°±1.5°, p=0.18). Vice versa, intraoperative reposition resulted in significant improvement of the angular deviation for the luxation (18.3°±14.7°, p=0.02) and burst (25.3°±14.0°, p=0.04) fractures, but not for the odontoid fractures (5.4°±8.6°, p=0.19).
Conclusion: PTGWT is an effective, safe, and well-tolerable treatment for cervical spine injuries with malalignment. The patients with the odontoid fracture might particularly profit from the PTGWT. In turn, there is a high capacity for intraoperative correction for the luxation and burst fractures of the cervical spine.
