Cervical Posttraumatic Unilateral Locked Facets: Clinical, Radiologic, and Surgical Remarks on a Series of 33 Patients.

Abstract

Radiographic and clinical analysis. Review author's experience with anterior discectomy, interbody fusion, and anterior cervical plating in 33 patients with posttraumatic unilateral cervical locked facets. Unilateral cervical locked facet syndrome is a relatively uncommon injury that often is misdiagnosed and therefore subject to a dangerous delay in surgery. Management of this trauma is controversial. Thirty-three patients with radiologically proven diagnosis of postraumatic unilateral cervical locked facets were treated by skull traction and surgical operation from January 2005 to December 2009. All patients preoperatively were assessed for neurological examination and underwent x-rays, magnetic resonance imaging, and computed tomography evaluation of the cervical spine. The unilateral locked facet level was C4-C5 in 13 patients, C5-C6 in 10, C6-C7 in 8, and C3-C4 in 2 patients. After closed reduction attempt with Crutchfield system, the correct alignment was achieved in 30 patients, who underwent anterior discectomy with cage, interbody fusion, and anterior cervical plating. In 3 patients there was an overdistraction and therefore a closed reduction was not possible, so they were firstly operated by posterior approach with opened reduction of the facets, lateral mass screws, and posterolateral fusion. In 2 of these patients there was an anterior fragment of the disk in the canal, so was also performed an anterior approach with discectomy, cage, and plating. There were no surgery-related complications. Postoperative neurological status was unchanged in the 3 patients with tetraplegia and improved in 8 of the 10 patients with radiculopathy. Fusion was obtained in all patients, as showed in the clinical and radiologic follow-up. The authors conclude that an anterior approach provides a safe and effective alternative for the treatment of patients with posttraumatic unilateral cervical locked facet, when preoperatively the cervical alignment of the dislocation is achieved with a closed reduction.