Cervical Facet Dislocation Research Articles

The Timing and Influence of MRI on the Management of Patients With Cervical Facet Dislocations Remains Highly Variable

Traumatic cervical facet dislocations are potentially devastating injuries. Magnetic resonance imaging (MRI) is an excellent means of assessing ligamentous disruption, disk herniation, and compression of the neural elements. However, despite an improved understanding of these facet dislocations with imaging, treatment remains controversial. To survey the timing and influence of MRI on the management of patients with traumatic cervical facet dislocations. Questionnaire study. Clinical vignettes, plain radiographs, and computed tomography scans of 10 cases of cervical facet dislocation were presented to 25 fellowship trained spine surgeons. Participants were analyzed as to their next step in diagnosis or treatment: closed reduction, obtaining an MRI, or proceeding directly with open treatment. A revised vignette was then presented; however, on this occasion, an MRI was included with the imaging and had been obtained before a reduction attempt. Participants were then surveyed on their choice of closed or open reduction. Each of the vignettes consisted of 3 different clinical scenarios based on neurologic examination: intact, incomplete, or complete spinal cord injury. The interrater reliability of treatment decisions was very poor, and the reliability after MRI was available and was significantly worse when the patient was considered to have a complete spinal cord injury. After reviewing the MRI, orthopedic surgeons were significantly more likely to choose a closed versus open reduction. Neurosurgeons were significantly more likely than orthopedic surgeons to order an MRI before open or closed treatment. The timing and utilization of MRI for patients with traumatic cervical facet dislocations remains variable. Further outcome analysis in the form of evidence-based algorithms is necessary to optimize patient management and outcomes.

Utility of Helical Computed Tomography in Differentiating Unilateral and Bilateral Facet Dislocations

Objective: Diagnosis of cervical facet dislocation is difficult when relying on plain radiographs alone. This study evaluates the interobserver reliability of helical computed tomography (CT) in the assessment of cervical translational injuries, correlates the radiographic diagnosis with intraoperative observation, and examines the role of neurologic injury in the evaluation and diagnosis of these injuries.Methods: Clinical histories and radiographic studies of 10 patients with cervical facet dislocations were presented to 25 surgeons. Participants classified cases as unilateral or bilateral facet dislocations after reviewing selected axial CT slices and sagittal reconstructions. Surgeons' interpretations were compared with intraoperative diagnosis. Participants interpreted the same radiographic studies with 3 different clinical scenarios: neurologically intact, incomplete, and complete spinal cord injury. Vertebral body translation from midsagittal CT was evaluated to confirm whether all unilateral facet dislocations had < 25% translation.Results: Interrater κ coefficient showed moderate agreement between observers in classifying injuries as unilateral or bilateral (κ: 0.54-0.58), regardless of neurologic status. Percent agreement among observers varied from 50% to 100% for each individual case. Agreement was statistically higher for bilateral facet dislocation (85%) than for unilateral dislocations (78%), with 1 unilateral fracture showing nearly 50% translation on a midsagittal image.Conclusions: The addition of helical CT to reconstruction enables spine surgeons to more reliably distinguish bilateral from unilateral cervical facet dislocations. Despite frequent occurrence of these injuries and presumed agreement on injury description, agreement may be improved by a more precise definition of facet dislocations and subluxations and thorough review of all imaging studies.

Biomechanics of Cervical Facet Dislocation

Objectives: The goal of this study was to compute the dynamic neck loads during simulated high-speed bilateral facet dislocation and investigate the injury mechanism. Methods: Ten osteoligamentous functional spinal units (C3/4, n = 4; C5/6, n = 3; C7/T1, n = 3) were prepared with muscle force replication, motion tracking flags, and a 3.3-kg mass rigidly attached to the upper vertebra. Frontal impacts of increasing severity were applied to the lower vertebra until dislocation was achieved. Inverse dynamics was used to calculate the dynamic neck loads during dislocation. Average peak impact acceleration required to cause dislocation ranged between 7.6 and 11.6 g. This resulted in dynamic neck loads applied at average peak rates of 906 Nm/s for flexion moment, 8017 N/ for anterior shear, and 8100 N/s for axial compression. To determine the temporal event patterns, the average occurrence Results: Among average peak loads, axial compression of 233.6 N was first to occur followed by anterior shear force of 73.1 N and flexion moment of 30.7 Nm. Among average peak motions, axial separation of 5.3 mm was first to occur followed by flexion rotation of 63.1 degrees and anterior shear of 21.5 mm. Subsequently, average peak posterior shear force of 110.3 N was observed as the upper facet became locked in the intervertebral foramina. Average peak axial compression of 6.6 mm occurred significantly later than all preceding events. Conclusions: During bilateral facet dislocation, the main loads included flexion moment and forces of axial compression and anterior shear. These loads caused flexion rotation, facet separation, and anterior translation of the upper facet relative to the lower. The present data help elucidate the injury mechanism of cervical facet dislocation.

Posterior Reduction/Fusion Followed by Anterior Decompression/Fusion of Unreduced Bilateral Facet Fracture-Dislocation in the Lower Cervical Trauma

We evaluate the results of posterior reduction/fusion followed by anterior fusion in 17 unreduced bilateral cervical facet fracture-dislocations with neurologic deficit. The patients were investigated for neurologic recovery [American Spinal Injury Association (ASIA) motor and sensory scale], fusion rate and period, complications, operating time, and canal-to-body ratio at the region of injury. At the last follow-up, the ASIA motor and sensory scores demonstrated a statistically significant increase. No patient showed aggravation of neurologic symptoms. Canal-to-body ratio was 0.60±0.33 preoperatively and 0.92±0.06 postoperatively, which is a statistically significant increase. Posterior reduction/fusion followed by anterior decompression/fusion in unreduced cervical bilateral facet dislocation should be familiar to spine surgeons. It is not complex and is a relatively nondangerous treatment.

Variations in Surgical Treatment of Cervical Facet Dislocations

Retrospective Survey Analysis. To explore surgeon preference in the choice of surgical approach in the treatment of traumatic cervical facet dislocations. The choice of surgical approach in the treatment of traumatic cervical dislocations is highly variable and maybe influenced by a variety of factors. The purpose of this study was to examine inter-rater reliability in choice of surgical approach. Twenty-five members of the Spine Trauma Study Group evaluated 10 cases of traumatic cervical dislocations. Evaluation of the case as a unilateral or bilateral injury and surgeon interpretation of the presence of a disc herniation as well as preferred surgical approach were assessed. Only slight agreement was observed among surgeons in the choice of surgical approach (Kappa < 0.1). This improved slightly when patients were assumed to have a complete spinal cord injury (Kappa = 0.15). Surgeons used more anterior approaches either alone or as the first stage in a combined approach when a disc herniation was present regardless of neurologic status of the patient. When a patient was neurologically intact, an anterior approach was more common than a posterior approach even when a disc herniation was not present. Combined approaches were preferred for the treatment of bilateral facet dislocations. The poor agreement on the treatment of these injuries likely reflects a combination of factors including surgeon training and experience. Treatment decisions are likely to be affected by the neurologic status of the patient, interpretation of a disc herniation, and the classification of the injury as a unilateral or bilateral injury.

Management of Cervical Facet Dislocations

Optimal management of unilateral and bilateral cervical facet fractures remains controversial. This article explores the evaluation and treatment options available, focusing on the controversy surrounding prereduction magnetic resonance imaging (MRI) and the choice of surgical approach. In addition, the authors propose a treatment protocol for cervical facet dislocations. Acute disk herniation and disruption is highly prevalent in traumatic cervical facet injury. Some authors maintain the necessity of prereduction MRI to identify those at risk for further prolapse of a herniated disk during closed reduction maneuvers. Others maintain the risk of neurologic deterioration is small in the appropriate patient. To date, no permanent neurological worsening has ever been documented following a closed cervical spine reduction in an awake, cooperative patient. The need for open internal fixation following reduction is widely accepted; however, surgical treatment options are diverse and include anterior, posterior, and combined approaches. Closed reduction of cervical facet dislocations without baseline MRI is appropriate in the awake, cooperative patient. Postreduction MRI is essential in identifying herniated disks and tailoring a surgical approach. An anterior approach is classically employed with a concurrent disk herniation, although a combined anterior and posterior approach is sometimes chosen due to the severity of ligamentous disruption associated with bilateral cervical facet dislocations.

Clinical Outcomes of 90 Isolated Unilateral Facet Fractures, Subluxations, and Dislocations Treated Surgically and Nonoperatively

A retrospective outcomes study. The purposes of this study were 1) to identify plausible patient and interventional variables that influence the outcome of unilateral facet injuries and 2) to determine if patients return to normal general health status after unilateral facet injuries. The management of unilateral subaxial cervical facet fractures and dislocations lacks agreement on treatment options and the variables that influence outcome. Injury data, radiographs, and outcomes (North American Spine Society Cervical Follow-up Questionnaire and Short Form-36) were collected from 9 centers and 13 surgeons, members of the Spine Trauma Study Group. Causally motor vehicle accidents (49%) and sports (31%) predominated. The C6-C7 level accounted for 60% of injuries and C5-C6 represented 17%. The mean SF-36 PCS score of the operative patients with follow-up >18 months was 6.70 points higher than the mean of the nonoperative patients (P = 0.017). The SF-36 Bodily Pain mean of all patients was 67.2 (SD = 27.6), significantly lower (more pain) than the normative mean of 75.2 (SD = 23.7) (P = 0.014). Nonoperative patients also reported a mean Bodily Pain score of 63.0 (SD = 30.5) that was significantly worse than normative values (P = 0.031). Similarly, the NASS PD mean score for all patients was 84.8 (SD = 17.9), significantly lower than the normative mean of 89.1 (SD = 15.5) (P = 0.014). To our knowledge this is the largest reported series of facet injuries to date and the only one using health-related quality of life instruments. Unilateral facet injuries of the subaxial cervical spine led to reported levels of pain and disability that are significantly worse than those of the healthy population. Although further study is required, we suggest that nonoperatively treated patients report worse outcomes than operatively treated patients, particularly at longer follow-up despite having a more benign fracture pattern. The presence of comorbidities, associated injuries, and advanced age adversely impact clinical outcomes.

Treatment of bilateral cervical facet dislocation by reduction through anterior distraction

To investigate the effect of reduction through anterior distraction in treatment of bilateral cervical facet dislocation. Twenty-one patients with bilateral cervical facet dislocation underwent leverage reduction through anterior distraction, interbody fusion, and internal fixation. Follow-up lasted 16 months (4 months to 5 years). All of the 21 patients got reduction of cervical facet dislocation and bony fusion. The neurological deficiency in 4 of the 21 patients improved. Simple and safe, reduction through anterior distraction is effective in treatment of bilateral cervical facet dislocation with reliable fusion.

Cervical facet joint kinematics during bilateral facet dislocation

Previous biomechanical models of cervical bilateral facet dislocation (BFD) are limited to quasi-static loading or manual ligament transection. The goal of the present study was to determine the facet joint kinematics during high-speed BFD. Dislocation was simulated using ten cervical functional spinal units with muscle force replication by frontal impact of the lower vertebra, tilted posteriorly by 42.5 degrees. Average peak rotations and anterior sliding (displacement of upper articulating facet surface along the lower), separation and compression (displacement of upper facet away from and towards the lower), and lateral shear were determined at the anterior and posterior edges of the right and left facets and statistically compared (P < 0.05). First, peak facet separation occurred, and was significantly greater at the left posterior facet edge, as compared to the anterior edges. Next, peak flexion rotation and anterior facet sliding occurred, followed by peak facet compression. The highest average facet translation peaks were 22.0 mm for anterior sliding, 7.9 mm for separation, 9.9 mm for compression and 3.6 mm for lateral shear. The highest average rotation of 63 degrees occurred in flexion, significantly greater than all other directions. These events occurred, on average, within 0.29 s following impact. During BFD, the main sagittal motions included facet separation, flexion rotation, anterior sliding, followed by compression, however, non-sagittal motions also existed. These motions indicated that unilateral dislocation may precede bilateral dislocation.

Delayed surgical management of a traumatic bilateral cervical facet dislocation by an anterior–posterior–anterior approach

Delayed diagnosis (more than one month after injury) of a bilateral cervical facet dislocation is exceptional, and delayed treatment is different from treatment in the acute stage. We describe a neurologically intact 51-year-old patient, in whom the diagnosis of bilateral cervical facet dislocation at C5/6 was made 10 weeks after the trauma. An anterior–posterior–anterior approach was performed, with repositioning during the posterior approach, and with anterior and posterior C5/6 fixation. The patient remained neurologically intact, and radiographic fusion was observed 3, 6, and 12 months postoperatively. Additionally, the (English) literature is reviewed and discussed.

Uncovertebral joint injury in cervical facet dislocation: the headphones sign

The purpose of our study is to demonstrate the uncovertebral malalignment as a reliable indirect sign of cervical facet joint dislocation. We examined the uncovertebral axial plane alignment of 12 patients with unilateral and bilateral cervical facet joint dislocation (UCFJD and BCFJD, respectively), comparing its frequency to the reverse hamburger bun sign on CT and MR axial images. Of the seven cases with BCFJD, five clearly demonstrated the diagnostic reverse facet joint hamburger bun sign on CT and MR images, but in two cases, this sign was not detectable.

The Radiographic Failure of Single Segment Posterior Cervical Instrumentation in Traumatic Cervical Flexion Distraction Injuries

Background/Objectives: Unilateral and bilateral cervical facet subluxations, dislocations, and/or fractures may be managed with anterior, posterior, or combined surgical approaches. The primary objective of this study was to identify radiographic features that predispose to poor radiographic outcomes (kyphosis) when these injuries are treated with single segment posterior cervical instrumentation and fusion. Method: A retrospective radiographic review was performed on 65 patients whose unilateral or bilateral facet subluxation/dislocations or fracture dislocation was managed with single segment posterior cervical instrumentation and fusion. The pre- and postoperative plain radiographs, CT, and MRI were assessed to identify the fracture type, degree of kyphosis, translation, and radiographic failure. Results: 2 patients (3.5%) demonstrated gross radiographic failure of the posterior instrumentation. Both had bilateral facet subluxation without fracture and ultimately required anterior revision. Kyphosis at...

The Comparative Study of Magnetic Resonance Angiography Diagnosis and Pathology of Blunt Vertebral Artery Injury

Observational and comparative study of the vertebral artery injury detected by 2-dimensional (2-D) time-of-flight magnetic resonance angiography (MRA) for admitting patients. Construct a strike-induced flexion injury model of cervical spine with blunt vertebral artery injury in dogs. To evaluate the value of MRA for diagnosing vertebral artery injury in cervical spinal trauma patients, and conduct a comparative study of MRA image and pathology of blunt vertebral artery injury in an animal experiment. The 2-D time-of-flight MRA is the most important method for diagnosing vertebral artery injury. However, there is still controversy over MRA's accuracy in detecting vertebral artery injury of varying degrees. In addition, to our knowledge, no animal studies regarding this subject have been found in the literature so far. In a clinical study, 319 patients with close cervical spinal trauma underwent 2-D time-of-flight MRA prospective examination. The 2-D time-of-flight MRA detected vertebral artery injury in 52 of the 319 subjects. Of the 52 patients, 51 had unilateral vertebral artery injuries, including 22 injuries on the left vertebral artery and 29 on the right vertebral artery. One case involved bilateral vertebral artery injury. In an animal experiment, the strike-induced flexion injury model of cervical spine was constructed based on an animal experiment with 26 adult dogs. A radiograph was taken immediately after injury, and 2-D time-of-flight MRA was taken in 24-36 hours. The vertebral artery sample was then harvested for pathologic examination. In the animal experiment, cervical facet dislocation occurred in 14 of the 26 dogs. Of the 26 dogs, 7 had unilateral vertebral artery injury as detected by MRA. There were 2 dogs that had incomplete blood flow imaging on one side of the vertebral artery, which MRA diagnosed as suspect positive. There were no vertebral artery injuries in the other 17 dogs. The vertebral artery sample of all 26 dogs underwent the pathologic study. Of the 7 dogs with positive MRA, 4 had disruption of the intima and media, and 3 had disruption of the intima. Of the 2 dogs with suspicious positive MRA diagnosis, 1 had no intima injury, while the other had intima disruption and late mural thrombus. There was no intima injury in the 17 dogs with negative MRA findings. The 2-D time-of-flight MRA is an effective diagnostic method for blunt vertebral artery injury. It may have difficulties differentiating spasm, small disruption of the intima from others under certain conditions.

Emergency Transport and Radiographic Evaluation Following Spinal Cord Injury

The prehospital care of patients with spinal cord injury has improved significantly since the founding of the Emergency Medical Services (EMS) in 1971. Rapid and safe transport of the spinal injury patient allows for early medical stabilization and institution of measures designed to preserve and possibly improve neurologic function. The adoption of systematic imaging protocols and advancements in imaging technology have allowed for early diagnosis of spinal injuries and therefore definitive treatment. Controversy still exists as to the basic imaging requirements needed to exclude the presence of spinal injury or the need for prereduction magnetic resonance imaging in a patient with a cervical facet dislocation.

Posterior longitudinal ligament status in cervical spine bilateral facet dislocations

It is generally accepted that cervical spine bilateral facet dislocation results in complete disruption of the posterior longitudinal ligament. The goal of this study was to evaluate the integrity of numerous spine-stabilizing structures by MRI, and to determine if any associations between injury patterns exist with respect to the posterior longitudinal ligament status. Retrospective case series. A retrospective review was performed of 30 cervical spine injury subjects with bilateral facet dislocation. Assessment of 1.5T MRI images was carried out for: intervertebral disc disruption, facet fracture, and ligamentous disruption. Statistical analyses were performed to evaluate for associations between various injury patterns and posterior longitudinal ligament status. The frequency of MRI abnormalities was: anterior longitudinal ligament disruption (26.7%), disc herniation or disruption (90%), posterior longitudinal ligament disruption (40%), facet fracture (63.3%) and disruption of the posterior column ligament complex (97%). There were no significant associations between injury to the posterior longitudinal ligament and other structures. Compared to surgical reports, MRI was accurate for determining the status for 24 of 26 ligaments (three of three anterior longitudinal ligament, seven of nine posterior longitudinal ligament, and 14 of 14 posterior column ligament complex) but generated false negatives in two instances (in both MRI showed an intact posterior longitudinal ligament that was torn at surgery). In contradistinction to the existing concept, the posterior longitudinal ligament can remain intact in a substantial proportion of hyperflexion injuries that produce bilateral cervical facet dislocation. Posterior longitudinal ligament integrity is not associated with any other injury pattern related to the anterior longitudinal ligament, intervertebral disc or facet fracture.

Uncovertebral joint injury in cervical facet dislocation: the headphones sign

The purpose of our study is to demonstrate the uncovertebral mal-alignment as a reliable indirect sign of cervical facet joint dislocation. We examined the uncovertebral axial plane alignment of 12 patients with unilateral and bilateral cervical facet joint dislocation (UCFJD and BCFJD, respectively), comparing its frequency to the reverse hamburger bun sign on CT and MR axial images. Of the seven cases with BCFJD, five clearly demonstrated the diagnostic reverse facet joint hamburger bun sign on CT and MR images, but in two cases this sign was not detectable. In the five cases with UCFJD, four demonstrated the reverse hamburger bun sign on both CT and MRI. In one case the reverse hamburger bun sign was not seen adequately with either image modality, but the facet dislocation was identified on sagittal imaging. The uncovertebral mal-alignment was detected in all 12 cases. Normally, the two components of the uncovertebral joint enjoy a concentric relationship that in the axial plane is reminiscent of the relationship of headphones with the wearer's head. We name this appearance the 'headphones' sign. Radiologists should be aware of the headphones sign as a reliable indicator of facet joint dislocation on axial imaging used in the assessment of cervical spine injuries.

Acute Quadriplegia Following Closed Traction Reduction of a Cervical Facet Dislocation in the Setting of Ossification of the Posterior Longitudinal Ligament

A case report of acute quadriplegia resulting from closed traction reduction of traumatic bilateral cervical facet dislocation in a 54-year-old male with concomitant ossification of the posterior longitudinal ligament (OPLL). To report an unusual presentation of a spinal cord injury, examine the approach to reversal of the injury, and review the treatment and management controversies of acute cervical facet dislocations in specific patient subgroups. The treatment of acute cervical facet dislocations is an area of ongoing controversy, especially regarding the question of the necessity of advanced imaging studies before closed traction reduction of the dislocated cervical spine. The safety of an immediate closed, traction reduction of the cervical spine in awake, alert, cooperative, and appropriately select patients has been reported in several studies. To date, there have been no permanent neurologic deficits resulting from awake, closed reduction reported in the literature. A case of temporary, acute quadriplegia with complete neurologic recovery following successful closed traction reduction of a bilateral cervical facet dislocation in the setting of OPLL is presented. The clinical neurologic examination, radiographic, and advanced imaging studies before and after closed, traction reduction of a cervical facet dislocation are evaluated and discussed. A review of the literature regarding the treatment of acute cervical facet dislocations is presented. Radiographs showed approximately 50% subluxation of the fifth on the sixth cervical vertebrae, along with computerized tomography revealing extensive discontinuous OPLL. The cervical facet dislocation was successfully reduced with an awake, closed traction reduction, before magnetic resonance imaging (MRI) evaluation. The patient subsequently had acute quadriplegia develop, with the ensuing MRI study illustrating severe spinal stenosis at the C5, C6 level as a result of OPLL or a large extruded disc herniation. Following an immediate anterior decompression and a posterior stabilization procedure, the patient regained full motor and sensory function. This case report highlights the advantages and shows some safety concerns regarding immediate, closed traction reduction of cervical facet dislocation with real-time neural monitoring in an awake, alert, oriented, and appropriately select patient before MRI studies in the setting of preexisting central stenosis from OPLL.

Analysis of patient variables affecting neurologic outcome after traumatic cervical facet dislocation

Background context Traumatic cervical facet dislocation accounts for a disproportionate rate of neurologic disability. The relative importance of patient and management variables, including the timing of spinal reduction, in ultimate neurologic outcome has not been well defined. Purpose To analyze data from a cohort of patients sustaining traumatic cervical facet dislocation to determine the relative importance of several patient and management variables in neurologic recovery after injury. Study design/setting A retrospective study was conducted at a major referral center for spinal-cord-injured patients. Patient sample Forty-five patients sustaining traumatic cervical facet dislocation. Outcome measures Using improvement in American Spinal Injury Association (ASIA) motor score as the primary outcome measure, patient data were used to construct a statistical model allowing the analysis of several clinically relevant variables. Methods The records of patients sustaining a traumatic cervical facet dislocation over a 5-year period were reviewed. Clinical data were collected for all patients with adequate follow-up. The data were used to construct a statistical model designed to analyze the contribution of the variables age, gender, time to reduction of the spine and initial motor score to neurologic improvement (the outcome measure). In addition, the effect of variable interaction was studied. Results Most patients demonstrated neurologic improvement over the course of follow-up after cervical facet dislocation. For this data set, the variables age and initial motor score were significantly associated with neurologic improvement. However, time to reduction of the spine did not demonstrate a significant independent relationship to neurologic outcome. No significant interaction was found between patient age or gender and the time to reduction with regard to predicting neurologic recovery. Conclusion The present study uses a statistical model to determine the relative importance of clinically relevant variables for a population of patients after traumatic cervical facet dislocation. This model confirms the clinical impression that younger patients with lesser degrees of neurologic injury tend to achieve the best neurologic recovery after a traumatic facet dislocation. Although a strong benefit from earlier spinal column reduction did not emerge from the present data set, additional study is needed to define those patients who would benefit from immediate reduction of the spinal column.

Minimally invasive lateral mass screws in the treatment of cervical facet dislocations: technical note.

The technique of lateral mass screw and rod or plate fixation is a major advancement in the posterior instrumentation of the cervical spine. This technique provides rigid three-dimensional fixation, restores the dorsal tension band, and provides highly effective stabilization in patients with many types of traumatic injuries. Patient 1 was a 32-year-old man who had been in a motor vehicle accident. He presented with right C5 radiculopathy. X-ray findings included 45% anterolisthesis of C4 on C5, bilateral facet disruption, and right unilateral C4-C5 facet fracture and dislocation. The patient was placed in Gardner-Wells tongs, and the fracture was reduced with 25 pounds of traction. Patient 2 was a 56-year-old woman who had been in a motor vehicle accident that resulted in complete quadriplegia. Her initial imaging studies revealed a C3-C4 right unilateral facet fracture with subluxation. She was placed in traction, and her neurological status was reassessed. The findings of her neurological examination revealed improvement: she was found to have Brown-Séquard syndrome. Patient 3 was a 33-year-old man who was involved in a diving accident that resulted in bilaterally jumped facets at C3-C4. The patient was neurologically intact, and attempts at closed reduction were not successful. Patients 1 and 2 underwent anterior cervical discectomy with iliac crest autograft fusion and plating. They were then placed in the prone position, and a dilator tubular retractor system was used to access the facet joint at the level of interest. The facet joints were then denuded and packed with autograft. Lateral mass screws were then placed by means of the Magerl technique, and a rod was used to connect the top-loading screws. Patient 3 underwent posterior surgery that included only removal of the superior facet, intraoperative reduction, and bilateral lateral mass screw and rod placement. This technical note describes the successful placement of lateral mass screw and rod constructs with the use of a minimally invasive approach by means of a tubular dilator retractor system. This approach preserves the integrity of the muscles and ligaments that maintain the posterior tension band of the cervical spine.

Reduction Techniques in Cervical Facet Dislocations

Reduction Techniques in Cervical Facet Dislocations