Thoracolumbar Spine Fracture-Dislocation without Neurological Deficit: A Case Report and Review of the Literature

Background: Thoracolumbar spine fracture-dislocations are very unstable and usually secondary to high energy trauma. Due to disruption of the entire vertebrae columns, the absence of neurological deficit is exceptional. Aim: The purpose of this work is to report our experience in the management of this entity in a context of limited resources and to make a review of the literature. Case presentation: A 30-year-old man was admitted with a severe low back pain after a traffic accident. Neurological functions were intact after examination. Radiological assessments revealed a complete L3-L4 fracture-dislocation. The patient underwent an open posterior reduction and internal long segment fixation. The post-operative was marked by a surgical site infection treated with surgical debridement and targeted antibiotic therapy. The neurological functions were preserved. Conclusion: Fracture-dislocations of the thoracolumbar spine are caused by high energy trauma and are remarkably unstable lesions. When they are associated with intact neurorological functions, reduction and stabilization of these fractures are a challenge.

Imaging evaluation of traumatic thoracolumbar spine injuries: Radiological review

Spine fractures account for a large portion of musculoskeletal injuries worldwide. A classification of spine fractures is necessary in order to develop a common language for treatment indications and outcomes. Several classification systems have been developed based on injury anatomy or mechanisms of action, but they have demonstrated poor reliability, have yielded little prognostic information, and have not been widely used. For this reason, the Arbeitsgemeinschaftfür Osteosynthesefragen(AO) committee has classified thorocolumbar spine injuries based on the pathomorphological criteria into3 types(A: Compression; B: Distraction; C: Axial torque and rotational deformity). Each of these types is further divided into 3 groups and 3 subgroups reflecting progressive scale of morphological damage and the degree of instability. Because of its highly detailed sub classifications, the AO system has shown limited interobserver variability. It is similar to its predecessors in that it does not incorporate the patient's neurologic status.The need for a reliable, reproducible, clinically relevant, prognostic classification system with an optimal balance of ease of use and detail of injury description contributed to the development of a new classification system, the thoracolumbar injury classification and severity score(TLICS). The TLICS defines injury based on three clinical characteristics: injury morphology, integrity of the posterior ligamentous complex, and neurologic status of the patient. The severity score offers prognostic information and is helpful in decision making about surgical vs nonsurgical management.

An expert consensus on the evaluation and treatment of acute thoracolumbar spine and spinal cord injury in China

This is an expert consensus on the evaluation and treatment of thoracolumbar spinal injury, estab- lished from February 2009 to July 2010. The expert consensus consists mainly of six parts with a total of 54 recommendations including the overview （one item）; pre-hospital care （one item）; evaluation and diagnosis （13 items）; treatment （23 items）; prevention and treatment of major com- plications （12 items）; and rehabilitation （four items）. This is the first time that Chinese experts have published a consensus on spine and spinal cord injury. The expert consensus was established based on Delphi methods, literature analysis, and clinical experiences. Each recommendation is supported by and was interpreted using multi-level evidences. The level of agreement with the rec- ommendation among the panel members was assessed as either low, moderate, or strong. Each panel member was asked to indicate his or her level of agreement on a 5-point scale, with ＂1＂ cor- respondJng to neutrality and ＂5＂ representJng maxJmum agreement. Scores were aggregated across the panel members and an arithmetic mean was calculated. This mean score was then translated into low, moderate, or strong. After all of the votes were collected and calculated, the results showed no low-level recommendations, 10 moderate-level recommendations, and 44 strong-level recom- mendations. An expert consensus was reached and was recognized by Chinese spine surgeons. Wide-scale adoption of these recommendations is urgent in the management of acute thora- columbar spine and spinal cord injury in a broader attempt to create a standard evaluation and treatment strategy for acute thoracolumbar spine and spinal cord injury in China.

Thoracolumbar spine fracture complicated by simple conus medullaris injury

Between 1990 and 1996, 15 patients with thoracolumbar spine fracture complicated by simple conusmedullaris injury were admitted. All patients were Injured by falling from height (mean, o meters). Clinical symp-toms indicated hypoesthesia or anesthesia of S3-5 sensory region,dysporia and urinary dysfunction. but normal sensation and motion of the bilateral lower extremities. Waston-Jones classified the spinal cord and nerve root injury following thoracolumbar spine fracture into three types. According to our observations, it should be classfied into five types: 1) concussion of the conus medullaris; 2) simple incomplete injury of the conus medullaris; 3) simplecomplete injury of the conus medullaris; 4) spinal cord transection and partial nerve root injury; 5) spinal cordtransection and entire nerve root injury.

Outcome of Long Segment Transpedicular Screw Fixation in Unstable Thoracolumbar Spine Injury with Incomplete Neurological Deficit

Background: Long segment transpedicular screw fixation in thoracolumbar spine injury has gained popularity in the last decades as it provides immediate stability, prevents further risk of complications and allows early mobilization of patient. Objectives: Evaluation of clinical and functional outcome after long segment transpedicular screw fixation in unstable thoracolumbar spine injury with incomplete neurological deficit patients. Methods: This quasi experimental study was conducted at Dhaka Medical College and Hospital (DMCH), Dhaka, Bangladesh from January 2016 to December 2017. A total of twenty four (24) patients with traumatic unstable fracture of the thoracolumbar spine with incomplete neurological deficit underwent long segment transpedicular screw fixation were included in this study. Clinical and radiologic outcomes were assessed pre-operatively and post-operatively. Results: A total of 24 patients aged between 20 - 60 years of both sexes (Male-21, Female-03) were included in this study. Their mean (±SD) age was 33.12 (±8.57) years. Most of them were farmer [09 (37.5%)] and day labour [08 (33.33%)]. Motor vehicle accidents were the most common [16 (66.67%)] cause of injury and then fall from height [08 (33.33%)]. The most common level of injury involved was L1-10 (41.67%) patients, followed by L2-07 (29.17%), T12-05 (20.83%) and T11-02 (8.33%) of the study patients. Burst fracture was the commonest [22 (91.67%)] type of fracture followed by Chance fracture [02 (8.33%)]. Pre-operative mean (±SD) Cobb angle, Kyphotic deformation of vertebral body, Beck index and vertebral compression deformity were 21.83 ± 4.5 degrees, 22.09 ± 4.40 degrees, 0.78 ± 2.65 and 0.18 ± 0.93 mm respectively, after procedure which were significantly (p Conclusions: Long segment transpedicular screw fixation is an effective method of treatment in patients having thoracolumbar spine injury with incomplete neurological deficit.

Exploration and Discussion on the Clinical Therapeutic Effects of the Application of Cross-Injury Vertebral Fixation and Via-Injury Vertebrae Fixation in the Treatment of Bone Tumor with Thoracolumbar Spine Fracture

Objective:To explore and discuss the clinical therapeutic effects of the application of cross-injury vertebral fixation and via-injury vertebrae fixation in the treatment of bone tumor with thoracolumbar spine fracture.Methods:A total of 58 patients with bone tumors and thoracolumbar spine fractures admitted to our hospital from February to February 2019 were selected as the study subjects.They were randomly divided into control group and observation group,with 29 cases in each group.The patients in the control group received cross-injury vertebral fixation treatment,while the patients in the observation group were treated with via-injury vertebral fixation.The therapeutic effects of the two groups were compared.Results:The operation time and hospitalization time of the observation group were significantly shorter than those of the control group(P<0.05),and the postoperative drainage volume of the intraoperative blood loss was significantly less than that of the control group(P<0.05).There was no significant difference in postoperative pain and spinal JOA scores between the two groups(P>0.05);there was no significant difference in the compression ratio of the injured vertebrae and the kyphosis Cobb angle between the two groups(P>0.05),after the operation,the two groups of patients were significantly reduced,and the compression ratio of the injured vertebrae and kyphosis Cobb angle of the observation group were more obvious(P<0.05);the vertebral height loss and Cobb angle loss in the observation group were significantly lower than those in the control group(P<0.05).Conclusion:In the treatment of bone tumor with thoracolumbar spine fracture,compared with cross-injury vertebral fixation,via-injury vertebral fixation has a more significant clinical effect and is more suitable for clinical application and promotion.

Algorhythm for Use of Percutaneous Short Fixation of Fractures Involving the Thoracolumbar Junction and Lumbar Spine

Study Design: Original article. Objective: Guidelines for deciding whether to perform open or percutaneous surgery in burst fractures. Summary of Background Data: The authors propose an algorithm for deciding whether to perform open surgery or percutaneous surgery with short fixation in patients with fractures of the thoracolumbar junction and lumbar spine. Methods: Between July 2005 and July 2009, 72 patients underwent surgical stabilization by posterior route for fractures of the thoracolumbar junction and lumbar spine. In 44 the lesion involved the thoracolumbar junction, in 28 the lumbar spine (L2 in6 cases, L3 in15 cases, L5 in7 cases). The fractures were assessed morphologically according to Magerl’s classification (52 type A, 12 type B, 8 type C). All patients were analyzed according to the algorithm proposed, according to which patients must fulfil certain criteria: the fracture must be Magerl type A.3, it must involve one level, McCormack score must be 6 or less, invasion of the spinal canal must be 25% or less according to Hashimoto’s formula, Magnetic Resonance Imating (MRI) must confirm discoligamentous integrity. Neurologically, the patient must be ASIA E. 25 patients (17 thoracolumbar junction, 8 lumbar spine) fulfilled these criteria and were treated by percutaneous short fixation. Results: The average length of the surgical procedure was 80 minutes and the loss of blood 10 cc. All patients were dismissed without brace and were submitted to follow-upComputed Tomography CTscan 3 and 6 months after surgery. Follow-up ranged from 6 months to 4 years. In all cases CT scan confirmed fusion and there were no cases of rupture of the device. None of the patients presented neurological deficits. Conclusion: The algorithm described permits a proper selection of patients with thoracolumbar fractures who can be treated by percutaneous short fixation, thus avoiding the risks connected with failure of the stabilization system.

Thoracolumbar surgery for degenerative spine diseases complicated with tethered cord syndrome:A case report

BACKGROUND Tethered cord syndrome(TCS) secondary to split cord malformation(SCM) is rare in adulthood.There is as yet no consensus about the optimal treatment method for adult patients with SCMs and degenerative spine diseases such as lumbar stenosis,spondylolisthesis and ossification of the ligamentum flavum(OLF).The tethered cord poses a great challenge to the decompression and fusion procedures for the intraoperative stretching of the spinal cord,which might lead to deteriorated neural deficits.Here,we report on a case to add our treatment experience to the medical literature.CASE SUMMARY We treated a 67-year-old female patient with type II SCM suffering from lumbar disc herniation,degenerative lumbar spondylolisthesis and thoracic OLF.The patient underwent thoracolumbar spinal fusion and decompression surgery for severe lower back pain,extensive left lower limb muscle weakness and intermittent claudication.After the thoracolumbar surgery,without stretching the tethered cord,the patient achieved complete relief of pain and lower extremity weakness at final follow-up.CONCLUSION For adult patients with underlying TCS secondary to SCM coupled with thoracic OLF and lumbar spondylolisthesis,a thoracolumbar fusion surgery could be safe and effective with the tethered cord untreated.It is critical to design individualized surgical protocols to reduce the stretch of the low-lying spinal cord.

Progress in the Treatment of Thoracolumbar Spinal Fractures with Internal Fixation of Injured Vertebrae with Screws

The thoracolumbar spine,due to its large range of motion and relatively fragile anatomical structure,is prone to traumatic fractures and has become one of the common types of fractures in clinical practice.Thoracic and lumbar fractures may lead to spinal instability,spinal stenosis,etc.,and early restoration of vertebral height and sequence is necessary.Although the technique of transpedicular screw internal fixation for traumatic vertebrae is effective in the short term,in the long run,there may be adverse situations such as fixation breakage and loosening,leading to loss of vertebral height and kyphosis deformity.The technique of internal fixation of injured vertebrae with screws is considered to minimize postoperative complications and is worthy of promotion and use.With the advancement of medical technology,imaging,and biomechanics,the treatment methods for thoracolumbar spinal fractures are becoming increasingly diverse.

Primary thoracolumbar intraspinal malignant melanoma:A case report

BACKGROUND Primary intraspinal malignant melanoma is a very rare tumor that most often occurs in the cervical,thoracic,or thoracolumbar segment.CASE SUMMARY A rare case of primary thoracolumbar malignant melanoma is described.A 45-year-old female patient complained of low back pain with numbness and fatigue in both lower limbs.MR revealed an intradural space-occupying lesion at the thoracic 12 to lumbar 1 level.The tumor was partially excised,and a malignant melanoma was confirmed by histopathology.CONCLUSION Primary intraspinal malignant melanoma has rarely been reported,and surgical resection and related characteristics and diagnoses have been discussed.

PCDH17 restricts dendritic spine morphogenesis by regulating ROCK2-dependent control of the actin cytoskeleton,modulating emotional behavior

Proper regulation of synapse formation and elimination is critical for establishing mature neuronal circuits and maintaining brain function.Synaptic abnormalities,such as defects in the density and morphology of postsynaptic dendritic spines,underlie the pathology of various neuropsychiatric disorders.Protocadherin 17(PCDH17)is associated with major mood disorders,including bipolar disorder and depression.However,the molecular mechanisms by which PCDH17 regulates spine number,morphology,and behavior remain elusive.In this study,we found that PCDH17 functions at postsynaptic sites,restricting the number and size of dendritic spines in excitatory neurons.Selective overexpression of PCDH17 in the ventral hippocampal CA1 results in spine loss and anxiety-and depression-like behaviors in mice.Mechanistically,PCDH17 interacts with actin-relevant proteins and regulates actin filament(F-actin)organization.Specifically,PCDH17 binds to ROCK2,increasing its expression and subsequently enhancing the activity of downstream targets such as LIMK1 and the phosphorylation of cofilin serine-3(Ser3).Inhibition of ROCK2 activity with belumosudil(KD025)ameliorates the defective F-actin organization and spine structure induced by PCDH17 overexpression,suggesting that ROCK2 mediates the effects of PCDH17 on F-actin content and spine development.Hence,these findings reveal a novel mechanism by which PCDH17 regulates synapse development and behavior,providing pathological insights into the neurobiological basis of mood disorders.

Demineralized Bone Matrix Fibers plus Allograft Bone for Multilevel Posterolateral Spine Fusion: A Game Changer?

Introduction: While autograft bone is the gold standard for multilevel posterolateral lumbar fusion, bone substitutes and graft extenders such as allograft bone, ceramics and demineralized bone matrix (DBM) have been used to avoid the morbidity and insufficient quantity associated with harvesting autologous bone. The primary objective of this retrospective study was to determine whether, in patients with increased risk of operative nonunion related to multilevel fusion, adding DBM fibers to mineralized bone allograft resulted in better fusion than using allograft alone. The secondary objectives were to evaluate how adding DBM fibers affects functional disability, low back pain, intraoperative blood loss and the nonunion rate. Methods: This retrospective study involved a chart review of consecutive patients who underwent multilevel lumbar spinal fusion and were operated on by a single surgeon. The patients were divided into two groups: 14 patients received mineralized bone allograft (control group) and 14 patients received a combination of mineralized bone allograft and DBM (experimental group). Patients were reviewed at a mean of 16.4 ± 2.2 months after surgery at which point CT scans were analyzed to determine whether fusion had occurred;Oswestry disability index (ODI) and pain were also evaluated. Results: A mean of 5 levels [min 2, max 13] were fused in these patients. Posterolateral fusion as defined by the Lenke classification was not significantly different between groups. The experimental DBM group had a significantly better composite fusion score than the control group (P Discussion: Adding DBM fibers to allograft bone during multilevel posterolateral spinal fusion was safe and produced better composite fusion than using allograft only as an autograft extender.

Thoracic spine infection caused by Pseudomonas fluorescens:A case report and review of literature

BACKGROUND The clinical incidence of spinal infection is gradually increasing,and its onset is insidious,easily leading to missed diagnosis and misdiagnosis,which may lead to serious complications such as nervous system dysfunction,spinal instability and/or deformity,and cause a huge burden on society and families.Early identification of the causative agent and precision medicine will greatly reduce the suffering of patients.At present,the main pathogenic bacteria that cause spinal infection are Staphylococcus aureus,Streptococcus,Pneumococcus,Escherichia coli,and Klebsiella.There are no reports of spinal infection caused by Pseudomonas fluorescens.CASE SUMMARY We report a 32-year-old female patient with spinal infection.She presented with flank pain,initially thought to be bone metastases or bone tuberculosis,and had a family background of tumors.Her clinical features and changes in imaging and laboratory tests led to the suspicion of thoracic spine infection.Histopathology of the lesion showed inflammation,tissue culture of the lesion was negative several times,and the possible pathogen-Pseudomonas fluorescens was found after gene sequencing of the lesion.The patient recovered completely after a full course of antibiotic treatment.CONCLUSION This report increases the range of pathogens involved in spinal infections,highlights the unique advantages of gene sequencing technology in difficult-todiagnose diseases,and validates conservative treatment with a full course of antibiotics for spinal infections without complications.

Ethanol changes Nestin-promoter induced neural stem cells to disturb newborn dendritic spine remodeling in the hippocampus of mice

Adolescent binge drinking leads to long-lasting disorders of the adult central nervous system,particularly aberrant hippocampal neurogenesis.In this study,we applied in vivo fluorescent tracing using NestinCreERT2::Rosa26-tdTomato mice and analyzed the endogenous neurogenesis lineage progression of neural stem cells(NSCs)and dendritic spine formation of newborn neurons in the subgranular zone of the dentate gyrus.We found abnormal orientation of tamoxifen-induced tdTomato+(tdTom^(+))NSCs in adult mice 2 months after treatment with EtOH(5.0 g/kg,i.p.)for 7 consecutive days.EtOH markedly inhibited tdTom^(+)NSCs activation and hippocampal neurogenesis in mouse dentate gyrus from adolescence to adulthood.EtOH(100 mM)also significantly inhibited the proliferation to 39.2%and differentiation of primary NSCs in vitro.Adult mice exposed to EtOH also exhibited marked inhibitions in dendritic spine growth and newborn neuron maturation in the dentate gyrus,which was partially reversed by voluntary running or inhibition of the mammalian target of rapamycinenhancer of zeste homolog 2 pathway.In vivo tracing revealed that EtOH induced abnormal orientation of tdTom+NSCs and spatial misposition defects of newborn neurons,thus causing the disturbance of hippocampal neurogenesis and dendritic spine remodeling in mice.

Academic Stress Assessment Using Virtual Reality as an Educational Tool in Spine Surgery

Introduction: The evaluation of academic stress in medical students and residents is a topic of significant interest, given the considerable challenges they face during their learning process with traditional teaching methods. The use of technologies like virtual reality presents an opportunity to enhance their skills through simulations and training. The main objective of this study is to qualitatively assess the stress levels experienced by medical students and residents by integrating virtual reality into their current learning methods, aiming to improve their ability to manage stressors in their practice. Material and Methods: A questionnaire was conducted with 12 medical students and 12 Traumatology and orthopedics residents. The purpose of the questionnaire was to evaluate the levels of academic stress using the SISCO inventory. The stress levels were calculated by transforming average values into percentages, and the following criteria were assigned: 0 to 33% for Mild Stress, 34 to 66% for Moderate Stress, and 67 to 100% for Deep Stress. Then, a virtual reality class focused on spine surgery was provided. Both medical students and residents were trained using the Non Nocere SharpSurgeon software platform and Oculus Quest 2 virtual reality glasses. At the end of the session, a second questionnaire related to the practice with virtual reality was conducted with the same evaluation criteria and a comparative analysis was carried out. Results: 12 undergraduate students from Hospital Angeles Mexico, CDMX and 12 traumatology and orthopedics residents at Hospital Santa Fe, Bogota were evaluated. The students in CDMX reported an average qualitative stress of 28.50% during habitual practices, which decreased to an average of 14.67% after virtual reality practice. Residents in Bogotá experienced an average qualitative stress of 30.50% with their current learning methods but this reduced to an average of 13.92% after using virtual reality. These findings indicate that the use of virtual reality has a positive impact on reducing stress levels qualitatively. Conclusions: The use of virtual reality as a learning method for medical students and residents qualitatively improves stress levels. Further studies are required to define the potential uses of Virtual Reality to improve learning methods and emotional state in medical students and residents and for a quantitative assessment to validate the training as certified learning methods.

Progress in The Application of Nursing Care Based on ERAS Concept after Thoracolumbar Fracture Surgery

Thoracic spine fracture is a common orthopedic injury that is usually caused by external forces acting directly on or transmitted to the thoracic spine through other parts of the spine.Thoracic spine fractures can be divided into two types:stable and unstable.An unstable fracture means that the relationship between the vertebral bodies is no longer stable,which may cause serious consequences such as spinal compression,nerve root compression,or spinal cord injury.Surgical treatment is often needed for patients with unstable fractures,nerve root compression,or spinal cord injury to restore stability and function to the thoracic spine.The probability of complications after thoracolumbar fracture surgery is high,which affects the outcome of surgical treatment.To improve postoperative rehabilitation outcomes,this article analyzed the value of nursing care based on the enhanced recovery after surgery(ERAS)concept for patients undergoing thoracolumbar fracture surgery.

TINAVI robot-assisted one-stage anteroposterior surgery in lateral position for severe thoracolumbar fracture dislocation:A case report

BACKGROUND The combined anterior/posterior approach appears to be capable of reconstructing spinal stability,correcting thoracolumbar deformity,and promoting neural recovery in severe thoracolumbar fracture dislocation.However,this type of operation requires changing the body position during the procedure,resulting in a lengthy operation time.As a universal surgical robot,TINAVI robot has achieved good surgical results in clinical surgery.But to our knowledge,no reports describing TINAVI robot-assisted single lateral position anteroposterior surgery for thoracolumbar fracture dislocation.CASE SUMMARY We describe a case of a 16-year-old female patient with severe thoracolumbar fracture and dislocation underwent surgery assisted by the TINAVI robot.A onestage combined anterior and posterior operation was performed on a severe thoracolumbar fracture dislocation using the TINAVI robot,and the operation was completed in right lateral position.CONCLUSION The TINAVI robot-assisted one-stage anterior and posterior surgery in right lateral position for severe thoracolumbar fracture and dislocation is both safe and effective.

Background,techniques,applications,current trends,and future directions of minimally invasive endoscopic spine surgery:A review of literature

Across many of the surgical specialties,the use of minimally invasive techniques that utilize indirect visualization has been increasingly replacing traditional techniques which utilize direct visualization.Arthroscopic surgery of the appendicular skeleton has evolved dramatically and become an integral part of musculoskeletal surgery over the last several decades,allowing surgeons to achieve similar or better outcomes,while reducing cost and recovery time.However,to date,the axial skeleton,with its close proximity to critical neural and vascular structures,has not adopted endoscopic techniques at as rapid of a rate.Over the past decade,increased patient demand for less invasive spine surgery combined with surgeon desire to meet these demands has driven significant evolution and innovation in endoscopic spine surgery.In addition,there has been an enormous advancement in technologies that assist in navigation and automation that help surgeons circumvent limitations of direct visualization inherent to less invasive techniques.There are currently a multitude of endoscopic techniques and approaches that can be utilized in the treatment of spine disorders,many of which are evolving rapidly.Here we present a review of the field of endoscopic spine surgery,including the background,techniques,applications,current trends,and future directions,to help providers gain a better understanding of this growing modality in spine surgery.

Comparative Transcriptome Analyses Reveal Genes Related to Spine Development in Cucumber (Cucumis sativus)

Fruit spine is an important quality trait of cucumber.To better understand the molecular basis of cucumber spine development and function,RNA-Seq was performed to identify differentially expressed genes(DEGs)in fruit spines of different development stages,namely,8 days before anthesis(SpBA8),anthesis(SpA)and 8 days after anthesis(SpAA8).Stage-wise comparisons obtained 2,259(SpBA8 vs.SpA),4,551(SpA vs.SpAA8),and 5,290(SpBA8 vs.SpAA8)DEGs.All the DEGs were classified into eight expression clusters by trend analysis.Among these DEGs,in addition to the Mict,Tril,CsTTG1,CsMYB6,NS,and Tu genes that have been reported to regulate fruit spine formation,we found that the CsHDG11,CsSCL8,CsSPL8,CsZFP6 and CsZFP8 may also be involved in spine development in cucumber.Our study provides a theoretical basis for further research on molecular mechanisms of spine development in cucumber.

Selection of Surgical Approach and Clinical Significance of Lower Cervical Spine Injuries Guided by SLIC Scoring System

Objective: To explore the feasibility and clinical significance of surgical approach selection for cervical spine injury guided by SLIC scoring system. Methods: The clinical data of 75 patients with lower cervical injury surgery from January 2020 to November 2022 were retrospectively analyzed, including 48 males and 27 females. Age: 28 - 65 years old. Causes of injury: 39 cases of traffic accidents, 15 cases of ice and snow sports, 12 cases of falling from high places, 9 cases of heavy objects. There were 12 cases of C3-4, 33 cases of C4-5, 21 cases of C5-6, and 9 cases of C6-7. Time from injury to medical treatment: 4 h - 2 d. Cervical spine X-ray, MRI, MDCT examination and preoperative SLIC score were performed on admission. Anterior approach was performed by subtotal cervical vertebrae resection or discectomy, titanium Cage or cage supported bone grafting and anterior titanium plate fixation. Posterior approach was performed with cervical laminoplasty, lateral mass or pedicle screw fixation and fusion. The combined anterior-posterior operation was performed by the anterior methods+ posterior methods. The time from injury to surgery is 12 h to 3 d. The function before and after operation was evaluated by JOA efficacy evaluation criteria. The correlation between the three surgical approaches and postoperative efficacy and SLIC score was compared. SPSS 22.0 software was used for statistical analysis of the data. Results: In this group of 75 patients, 32 cases of anterior operation, 22 cases of posterior operation and 21 cases of combined operation were followed up for no less than 12 months. There was no significant difference in age, gender, injury cause, injury segment, time from injury to treatment, and time from injury to operation among the three surgical approaches, which were comparable. The SLIC scores of mild, moderate and severe injuries of anterior surgery, posterior surgery and combined anterior and posterior surgery, They were (5.26 ± 1.24, 5.86 ± 1.67, 8.25 ± 0.21), (5.57 ± 1.43, 5.99 ± 1.85, 9.00 ± 0.25), (0, 5.98 ± 0.33, 9.44 ± 0.34), respectively. By comparing the SLIC scores and JOA scores of anterior surgery and posterior surgery, there was no difference in SLIC scores and JOA scores between the two groups for mild and moderate injuries (P > 0.05). However, the JOA scores at 3 months, 6 months and 12 months after surgery were different from those before surgery, and the postoperative efficacy and JOA scores were significantly improved (P & lt;0.05), indicating that the two surgical methods had the same therapeutic effect, that is, anterior or posterior surgery could be used to treat mild or moderate injuries (P > 0.05). There were differences in SLIC scores among the three surgical approaches for severe injury (P 0.05). The postoperative efficacy and JOA score of combined anterior-posterior approach were significantly improved compared with those before operation (P Conclusion: SLIC score not only provides accurate judgment for conservative treatment or surgical treatment of cervical spine injury, but also provides evidence-based medical basis and reference value for the selection of surgical approach and surgical method. According to the SLIC score, the surgical approach is safe and feasible. When the SLIC score is 4 - 7, anterior surgery is selected for type A injury, and posterior surgery is selected for type B injury. When the SLIC score is ≥8, combined anterior-posterior surgery should be selected. It is of great significance for clinical formulation of precision treatment strategy.