Anterior pedicle screw and plate fixation for cervical facet dislocation: case series and technical note

Abstract

Background ContextThe anterior-only surgical procedure is used as a recommended approach in the treatment of cervical facet dislocations, but an anterior cervical spine implant that offers higher three-column instabilities for stronger fixation is lacking. PurposeThis study aimed to report a new surgical technique of anterior pedicle screw (APS) fixation for cervical facet dislocations and the results of 12 patients with successful application and described safety. Study DesignThe study design includes case series and technical report. Patient SampleThe sample comprises 12 patients with cervical facet dislocations. Outcome MeasuresAnalyses of plain lateral neutral and oblique radiographs and computed tomography scans were conducted to assess reduction, fusion, and the accuracy of pedicle screw placement. Spinal cord compression and decompression was defined by a 1.5-Tesla magnetic resonance imaging. Neurologic status was evaluated according to classification of American Spinal Injury Association (ASIA). MethodsTwelve patients with cervical facet dislocations were surgically treated by the anterior cervical pedicle screw and plate fixation. In these 12 patients (9 male and 3 females), the distribution of spine level was from C3–C4 to C6–C7; the etiologic diagnosis included four unilateral and eight bilateral facet dislocations; the neurologic status comprised four patients with ASIA A, two with ASIA B, two with ASIA D, and four with ASIA E. After discectomy, reduction, and insertion of a peek cage containing autologous bone graft, the APS was inserted along the pedicle axis with the fluoroscope-assisted view imaging. ResultsPostoperatively, all patients had obtained successful reduction and satisfactory anatomic sagittal alignment. There was no complication or instrument failure owing to the use of this technique. Four ASIA A and one ASIA B patients showed no neurologic improvement; one ASIA B patient was improved neurologically to ASIA C; two patients with ASIA D were improved neurologically to ASIA E; no ASIA E patients showed neurologic deterioration. ConclusionsAnterior pedicle screw and plate fixation represents a safe and efficacious but technically challenging option for the treatment of cervical facet dislocations.