CLINICAL ORTHOPAEDICS AND RELATED RESEARCH Number 411, pp. 61–69 © 2003 Lippincott Williams & Wilkins, Inc. 61 The authors reviewed the medical records of 53 patients with a lower cervical spine injury who were treated by anterior decompression, bone grafting, and instrumentation using an anterior cervical spine plate and screws. The average age of the patients was 36 years and the mean fol- lowup was 58 months. Twenty-six patients pre- dominantly had anterior lesions and 27 patients predominantly had posterior lesions. Thirteen patients were neurologically intact. Fusion was achieved in all patients at an average of 3.4 months postoperatively. Radiographic followup detected 15% of hardware malposition. There were no pseudarthrosis, dysphagia, or neuro- logic complications. Incomplete spinal cord le- sions improved on average one Frankel grade after surgery. Anterior decompression and sta- bilization is a safe and effective procedure for the treatment of acute lower cervical spine in- juries and permits immediate postoperative mo- bilization of the patient. The earliest reports on achieving arthrodesis of the cervical spine were done by Bailey and Badg- ley, 8 Smith and Robinson, 31 and Cloward. 14 In 1970, Orosco and Llovet 26 described the use of a small-fragment plate for achieving ante- rior osteosynthesis. This plate later evolved to the H and double-H plates, and in 1976 Sene- gas and Gauzere 29 described the use of a sim- ilar H-shaped plate of the Association for the Study of Internal Fixation (ASIF). Since its early description, 3,11,17 engineer- ing improvements in internal fixation for the anterior cervical spine and increased expertise in instrumentation have augmented the ten- dency toward anterior stabilization of all un- stable lower cervical injuries, except irre- ducible dislocations. 23 Aebi et al 4,6 concluded that anterior bone grafting and plating for cer- vical spine lesions involving the anterior col- umn and for posterior osteoligamentous le- sions, is a straightforward, relatively atraumatic and reliable technique, when properly done. The goal of the current study was to analyze the outcome of anterior surgery for unstable cervical spine injuries with special attention given to technical aspects and complications. MATERIALS AND METHODS During a 12-year period, 82 patients had surgical treatment for acute lower cervical trauma at the au- thors’ institution. Of these 82 patients, 61 patients were treated with an anterior procedure alone (58 patients), or combined with posterior stabilization (three patients). Two patients with quadriplegia Anterior Surgery for Unstable Lower Cervical Spine Injuries Elias Lambiris, MD; Panayotis Zouboulis, MD; Minos Tyllianakis, MD; and Elias Panagiotopoulos, MD From the Orthopaedic Department, University of Patras Medical School, Rion-Patras Greece. Reprint requests to Elias Lambiris, MD, Orthopaedic De- partment, University Hospital of Patras, Rion – Patras, 26500, Greece. Phone: 30-2610-999555; Fax: 30-2610- 994579; E-mail: lambiris@med.upatras.gr. DOI: 10.1097/01.blo.0000068185.83581.cf