Effect of anterior distraction and leverage reduction for lower cervical spine fracture and dislocation combined with locked facet

Abstract

Objective To evaluate the efficacy and safety of anterior distraction and leverage reduction for lower cervical spine fracture and dislocation combined with locked facet. Methods Sixty-one patients with lower cervical spine fracture and dislocation combined with locked facet presenting to hospital between January 2009 and July 2014 were analyzed retrospectively. There were 48 males and 13 females, aged 18-81 years (mean, 48.6 years). Responsible injured segments were C3/4 in eight patients, C4/5 in 15, C5/6 in 23, C6/7 in 11 and C7/T1 in four. A total of 18 patients had unilateral locking of facets and 43 patients bilateral locking of facets. American Spinal Injury Association (ASIA) impairment score was grade A in nine patients, grade B in 13, grade C in 17, grade D in 16 and grade E in six. Under general anesthesia, the patients were performed decompression, reduction and fixation through cervical anterior approach. Postoperative intervertebral height, vertebral horizontal displacement and cervical kyphosis angle and reduction condition were evaluated. Interbody fusion was evaluated using the Bridwell criterion, neurological function using the ASIA score, and spinal cord function using the Japanese Orthopedic Association (JOA) score. Results Complete reduction was achieved in all patients. Fifty-six patients received 3-36 month follow- up (mean, 18 months). A second surgery was required for the postoperative recurrent dislocation in one patient and postoperative delayed union was seen in two patients. No patients had perioperative complications such as incision infection, nerve damage and esophageal injury. All incisions were stage I/first category healed. Cervical physiological curvature and intervertebral height were well maintained. Intervertebral height improved from preoperative 39%-86%[(67.6±14.1)%] to postoperative 89%-109%[(101.2±15.1)%], horizontal displacement of vertebrae improved from preoperative 5.36-11.74 mm [(8.12±1.89)mm] to postoperative 0- 2.56 mm [(1.29±0.29)mm], and Cobb angle improved from preoperative -3°- 26° [(14.3±6.2)°] to postoperative- 13°- 7°[(-3.6±0.7)°] (all P<0.05). Nerve function was improved with no aggravation after operation. JOA score was 0 to 17 points [(13.9±0.7)points] at follow-up versus 0-17 points [(7.3±0.9)points] before operation (P<0.01), and the improvement of spinal cord function was 68% after operation. Conclusion Anterior distraction and leverage reduction effectively improves spinal function, indicating an effective and save method in the treatment of cervical spine fracture dislocation combined with locked facet. Key words: Cervical spine; Dislocation; Zygapophyseal joint; Fracture fixation