Management of Neglected AO Type C Sub-axial Cervical Spine Injuries with a 540° Surgical Approach

Abstract

Neglected sub-axial cervical spine Arbeitsgemeinschaft für Osteosynthesefragen (AO) type C fracture-dislocations, especially without neurological deficit, are rare but present significant challenges due to chronic instability, fibrous/bony ankylosis, and the potential for neurological compromise. Timely surgical intervention in such cases is crucial for achieving a stable reduction and preventing impending neurological deterioration. We describe the clinical profile, surgical management, and outcomes of patients with neglected AO type C sub-axial cervical spine injuries without neurological deficit managed using a 540° anterior–posterior–anterior (APA) approach. Seven patients (six males and one female) with neglected sub-axial cervical dislocations without neurological deficit were treated at our institution between March 2013 and April 2025. Neglected injuries were defined as presentation more than 3 weeks after trauma; the mean delay to presentation was 67.7 days (range: 24–180 days). Clinical presentation, imaging findings, surgical technique, and outcomes were analyzed retrospectively. All patients were managed surgically using the 540° APA approach, and successful reduction and stabilization were achieved in all patients without neurological deterioration. Radiological fusion and sagittal alignment were achieved and maintained in all cases at the 6-month follow-up. No intraoperative or postoperative complications were observed. The 540° APA approach is a safe and effective surgical strategy for managing neglected AO type C cervical injuries without neurological deficit. This method enables thorough decompression, facet mobilization, and biomechanically sound reconstruction in chronic cases.