Single Level Arthrodesis as Treatment for Midcervical Fracture Subluxation

Abstract

Although many different techniques exist for fusion of midcervical facet fracture dislocations, limiting arthrodesis to a single level could have a theoretical advantage: fewer fused segments could lessen long-term negative effects of fusion on adjacent segments. Therefore, we prospectively treated 22 consecutive patients with midcervical fracture dislocation without vertebral body fracture with single level arthrodesis even if anterior/posterior surgery were required. Twelve patients with unilateral facet subluxation underwent anterior cervical discectomy, distraction reduction with Caspar posts (AESCULAP, Tuttlingen, Germany) with allograft fusion and anterior cervical plating. Ten patients with any component of bilateral facet subluxation underwent anterior cervical discectomy, distraction reduction with Caspar posts, allograft fusion and plating followed by posterior lateral mass plating. No patients demonstrated worsening of nerve root or spinal cord function postoperatively. Interbody stability occurred in all cases. Only complications were 4 cases of pneumonia, 1 case of wound leakage, and 1 case of superficial wound infection. Good reduction was achieved for both unilateral and bilateral facet fractures. Single level interbody arthrodesis is safe and effective strategy with both unilateral and bilateral facet fractures. Single level arthrodesis may also offer long-term benefit compared with multilevel fusions.