Distractive flexion injuries (DFI) of subaxial cervical spine are common after motor car accident or falling from height. The ideal surgical approaches to DFI are still unclear. A retrospective comparative study of surgical approaches for DFI of sub-axial cervical spine involved 60 patients throughout the years 2014 to 2016 at Al-Azhar University Hospitals. All patients were undergoing initial routine resuscitative measures, full general and neurological examinations. Neurologic function was assessed according to modified Frankel’s grading. All patients were received cervical plain antero-posterior, lateral and oblique X-ray, CT with 3D and MRI of cervical spine. Severity of DFI injury was assessed according to Allen and Ferguson’s classification. The most common level involved was C5-6 and most common grade was grade 3. The patients operated through anterior approach were 36 patients and through the posterior approach were 24 patients. Restoring cervical alignment was achieved in 29 patients (80.56%). The mean time of bone fusion was 5.454 months in anterior approach while it was 9.876 months in posterior approach. The extend of bone fusion was good in 30 patients (83.33%) after anterior approach and in 8 patients (33.33%) after posterior approach, while poor fusion was observed in 6 patients (16.67%) after anterior approach and 16 patients (66.67%) after posterior approach. We can conclude that anterior cervical approach is better in DFI stage 3 and 4 where there are associated ruptured intervertebral disc. Posterior approach is better in DFI stage 1 and 2 with or with presence of posterior compressing lesion.
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