Inadequacy of anterior-only fixation for reducible three-column injury of the subaxial cervical spine: case report

Abstract Introduction: Managing three-column injuries in the subaxial cervical spine in patients with prior spinal fusion surgery is complex. Current treatment algorithms generally advocate that an anterioronly approach is adequate for reducible subaxial cervical spine injuries. However, comprehensive studies on cervical trauma in patients with previously fused spines are lacking. Case presentation: We report a case of a 62-year-old male with a history of C4 to C6 anterior cervical spine fusion. The patient sustained a C6–C7 translational injury from a fall. Despite successful intraoperative reduction and anterior instrumentation, instrument failure occurred within a month without further trauma. This complication may be due to increased mechanical load from the fused segments above the injury site. Conclusion: This case underscores the need for customized treatment strategies for patients with prior spinal fusion surgery. Initial circumferential stabilization might be crucial to distribute mechanical loads effectively and prevent instrument failure. Further research is necessary to develop definitive management protocols for these challenging cases.