Optimization of surgical fixation in cervical spine fractures using advanced imaging techniques: a systematic review of functional and neurological outcomes

Jesús Jiménez-Sánchez; Diego Alberto García Cortés; Ninoska Andrea Fuentes Sánchez; Juan Pablo Lasso Bravo; Juan Carlos Arce Vivas; Norman Baldelmir Olmedo Raza; Ayrthon Ezequiel Olmedo Salvador; Sebastián Barragán Barreto

doi:10.18203/issn.2455-4510.IntJResOrthop20251747

Authors

Jesús Jiménez-Sánchez Department of Neurosurgery, Instituto Mexicano del Seguro Social, Mexico
Diego Alberto García Cortés Department of Orthopaedic Surgery, IMSS Victorio de la Fuente Narvaez, Mexico
Ninoska Andrea Fuentes Sánchez Department of Medicine, Universidad Andrés Bello, Chile, South America
Juan Pablo Lasso Bravo Department of Medicine, Universidad Internacional del Ecuador, Ecuador, South America
Juan Carlos Arce Vivas Department of Medicine, Universidad ICESI, Colombia, South America
Norman Baldelmir Olmedo Raza Faculty of Medical Sciences, Central University of Ecuador, Ecuador, South America
Ayrthon Ezequiel Olmedo Salvador Department of Imagenology, OPTIMAGEN, Ecuador, South America
Sebastián Barragán Barreto Department of Medicine, Fundación Universitaria Sanitas, Colombia, South America

DOI:

https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20251747

Keywords:

Advanced imaging, CT, Cervical spine fractures, MRI, Neurological outcomes, Surgical fixation

Abstract

Cervical spine fractures are high-stakes injuries with substantial risks of permanent neurological damage and disability. Traditional imaging methods, including plain radiographs and fluoroscopy, are limited by low sensitivity and spatial resolution. This systematic review assesses the impact of advanced imaging specifically preoperative MRI, CT and intraoperative navigation systems on surgical fixation accuracy and patient outcomes. In methodology, we followed PRISMA guidelines, a comprehensive literature search was conducted across PubMed, Scopus and Web of Science from 2010 to 2024. Eligible studies included adult patients with cervical spine trauma undergoing surgical fixation with reported outcomes in screw accuracy, neurological recovery (ASIA scores) or functional status (JOA, NDI, SF-36). Data were synthesized and quality assessed using the Newcastle-Ottawa Scale. In results, eleven studies (n=1,220 patients) met inclusion criteria. Intraoperative CT-based navigation consistently improved screw accuracy (up to 98.1%), reduced malposition and operative times and minimized radiation to staff. MRI influenced surgical decision-making in elderly and neurologically impaired patients, particularly by identifying occult cord compression and reducing surgical delay. Select studies reported functional gains, including ODI improvements from 67.1% to 25.6% and VAS pain reduction from 8.2 to 2.2. Advanced imaging modalities significantly enhance surgical precision and contribute to improved patient safety and recovery in cervical spine trauma. Their integration into surgical planning supports evidence-based, patient-centered care, especially in high-risk or anatomically complex cases.

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