Dislocation Of Cervical Spine Research Articles

Blunt Traumatic Vertebral Artery Injury After Cervical Fracture Dislocation: A Systematic Review of the Literature.

Certain high-energy blunt forces may produce unstable cervical fractures with or without dislocation. In rare cases where the superior facets are dislocated, however showing a significant increase within the last decade, these types of injuries may include vertebral artery entrapment at the involvement level leading to artery dissection or occlusion. This phenomenon is usually seen at the C4-C5 and C5-C6 levels of injury. A systematic review of the literature was performed by examining online databases such as PubMed - NCBI, Web of Science, Cochrane Library, Scopus, and Embase to identify relevant scientific articles. Keywords (MeSH terms) used in the search included cervical spine injuries, cervical spine dislocation, cerebrovascular injury, vertebral artery injury, vertebral artery injury management, and incidence of vertebral artery injury. Initially, 1516 studies were identified as a primary search for screening. After excluding papers that did not fulfill the inclusion criteria, 34 studies were included in this review. Vertebral artery injury consists of a severe complication that could compromise a surgical intervention since the patient's clinical image may be unrevealing at first. Early diagnosis and correct timing constitute the golden standard for adequate treatment. This systematic review aims to summarize the current evidence for the diagnosis, management, and treatment of blunt traumatic vertebral artery injuries.

Mechanisms and risk factors associated with spinal cord injury, facet fracture, and level of dislocation, in occupants with cervical spine dislocations sustained in motor vehicle crashes

Objective Motor vehicle crashes (MVCs) are the leading cause of cervical spine dislocation. The mechanisms underlying this injury are unclear, limiting the development of injury prevention devices and strategies. MVC databases contain occupant, medical, vehicle, and crash details that are not routinely collected elsewhere, providing a unique resource for investigating injury mechanisms and risk factors. In this study, a comprehensive standalone analysis of cervical spine dislocations captured in MVC databases was performed. Methods Epidemiologic, biomechanical, and injury data were extracted from three MVC databases. Logistic regression models were developed to determine the occupant, vehicle, and crash characteristics, as well as the global (inertial or impact) and regional (flexion, compression, etc.) loading mechanisms associated with the level of cervical spine dislocation (axial or sub-axial), and the occurrence of spinal cord injury (SCI) or facet fracture concomitant to dislocation. Results There was no association between global or regional injury mechanisms and the level of cervical spine dislocation. Sub-axial dislocations were typically due to head/face impact with the airbag or upper interior components, or a result of seatbelt restraint of the torso. Higher occupant age, lower BMI, partial/no ejection, and frontal and side configuration crashes (compared to rollovers) were associated with a higher likelihood of sub-axial, versus axial, dislocation. Amongst all dislocations, an increased likelihood of SCI was associated with impact injuries, airbag non-deployment, and complete ejection, while concomitant facet fracture was associated with the presence of regional compression. Severe crashes, partial ejections, and “utility vehicles” and “vans and trucks” (compared with “passenger vehicles”) were associated with a higher risk of facet fracture concomitant to sub-axial dislocation. Conclusion The findings of this study may be used to inform the loading modes to be simulated in future ex vivo or computational models seeking a better understanding of cervical spine dislocations.

Case report: A complete lower cervical fracture dislocation without permanent neurological impairment

BackgroundComplete fractures and dislocations of the lower cervical spine are usually associated with severe spinal cord injury. However, a very small number of patients do not have severe spinal cord injury symptoms, patients with normal muscle strength or only partial nerve root symptoms, known as “lucky fracture dislocation”. The diagnosis and treatment of such patients is very difficult. Recently, we successfully treated one such patient.Case presentationA 73-year-old male patient had multiple neck and body aches after trauma, but there was sensory movement in his limbs. However, preoperative cervical radiographs showed no significant abnormalities, and computed tomography (CT) and magnetic resonance imaging (MRI) confirmed complete fracture and dislocation of C7. Before operation, the halo frame was fixed traction, but the reduction was not successful. Finally, the fracture reduction and internal fixation were successfully performed by surgery. The postoperative pain of the patient was significantly relieved, and the sensory movement of the limbs was the same as before. Two years after surgery, the patient’s left little finger and ulnar forearm shallow sensation recovered, and the right flexion muscle strength basically returned to normal.ConclusionThis case suggests that when patients with trauma are encountered in the clinic, they should be carefully examined, and the presence of cervical fracture and dislocation should not be ignored because of the absence of neurological symptoms or mild symptoms. In addition, positioning during handling and surgery should be particularly avoided to increase the risk of paralysis.

Sports-Related Cervical Spine Injury: A Series of Two Cases with Literature Review

AbstractSports-related cervical injuries pose a significant concern in the realm of sports medicine, affecting athletes across various disciplines and levels of competition. Cervical injuries in sports primarily result from a combination of high-impact forces, sudden acceleration–deceleration movements, and improper techniques. Common cervical injuries include sprains, strains, fractures, and more severe conditions such as cervical spine dislocations. The mechanisms underlying sports-related cervical injuries involve complex interactions between biomechanical forces, player dynamics, and environmental factors. Understanding the biomechanics of these injuries is crucial for developing effective preventive strategies. This study highlights the mechanism of injury, primary intervention including transport of athletes, and medical and surgical management with the help of two such cases managed in a single institute in this year, 2023. By addressing the multifaceted aspects of these injuries, the sports community can strive toward creating a safer environment for athletes and minimizing the impact of cervical injuries on their overall well-being and athletic performance.

Non-traumatic complete cervical spine dislocation with severe fixed kyphosis: successful multidisciplinary approach to a challenging case

BackgroundTo our knowledge, there is no previous report in the literature of non-traumatic neglected complete cervical spine dislocation characterized by anterior spondyloptosis of C4, extreme head drop, and irreducible cervicothoracic kyphosis.Case presentationWe report the case of a 33-year-old Caucasian man with a 17-year history of severe immune polymyositis and regular physiotherapy who presented with severe non-reducible kyphosis of the cervicothoracic junction and progressive tetraparesia for several weeks after a physiotherapy session. Radiographs, computed tomography, and magnetic resonance imaging revealed a complete dislocation at the C4–C5 level, with C4 spondyloptosis, kyphotic angulation, spinal cord compression, and severe myelopathy. Due to recent worsening of neurological symptoms, an invasive treatment strategy was indicated. The patient’s neurological status and spinal deformity greatly complicated the anesthetic and surgical management, which was planned after extensive multidisciplinary discussion and relied on close collaboration between the orthopedic surgeon and the anesthetist. Regarding anesthesia, difficult airway access was expected due to severe cervical angulation, limited mouth opening, and thyromental distance, with high risk of difficult ventilation and intubation. Patient management was further complicated by a theoretical risk of neurogenic shock, motor and sensory deterioration, instability due to position changes during surgery, and postoperative respiratory failure. Regarding surgery, a multistage approach was carefully planned. After a failed attempt at closed reduction, a three-stage surgical procedure was performed to reduce displacement and stabilize the spine, resulting in correct spinal realignment and fixation. Progressive complete neurological recovery was observed.ConclusionThis case illustrates the successful management of a critical situation based on a multidisciplinary collaboration involving radiologists, anesthesiologists, and spine surgeons.

Traumatic C2-C3 Coronal Dislocation with Vertebral Artery Injury: Case Report and Literature Review

Introduction: The coronal subluxation of C2-C3 (lateral leisthesis or non-hangman fracture) is extremely rare and difficult to manage. In this paper, we report a case of a 21-year-old male who came to the ER after a motor vehicle accident (MVA) with C2-C3 lateral leisthesis and, surprisingly, mild neurological symptoms.
 Method: This systematic review was conducted following the recommendations of the preferred reporting items for systematic reviews and meta‐analyses (PRISMA) checklist. On January 1, 2022, a comprehensive electronic search was conducted through Scopus, PubMed, and Web of Science databases to retrieve original studies.
 Results: Seven articles were found reporting on non-hangman traumatic C2/C3 subluxation, with only two cases reporting coronal subluxation or lateral listhesis of C2 over C3. The first case was reported by Rajasekaran et al. Singh reported the second case. Both cases were unilateral facet dislocations with no radiological evidence of intervertebral disc disruption or herniation. We will report the third case in the literature of a non-hangman C2/C3 coronal dislocation. The patient underwent intraoperative manual traction under continuous neurophysiology monitoring. After the satisfactory reduction, fixation was carried out using lateral mass and pars screws from C1 to C3. Postoperatively, the patient recovered well, showed no signs of motor impairment during examination, and was discharged on the fifth day.
 Conclusion The impact of cervical spine injury is tremendous at every level. Management of cervical spine dislocation injury is full of controversies. The C2/C3 traumatic coronal translation with no disc involvement and unilateral facet dislocation may have a better outcome.

A SURVEY OF THE PRACTICE OF CERVICAL TRACTION REDUCTION IN THE WESTERN CAPE

A retrospective follow-up study was done, assessing regional practices in acute cervical reduction in hospitals in the Western Cape. The constitutional court ruled on the urgency in managing cervical dislocations, and our task is to ensure that medical treatment is optimized to comply with best medical practice and the apex court. A questionnaire was distributed and completed by emergency departments at each hospital, the results retrieved, analysed, and compared to a similar survey done in 2016.Protocols for managing cervical spine dislocations had improved from 80% having no protocols to only over half of facilities (52,6%) not having protocols in place. Inadequate equipment availability remained a problem with only 50% of facilities having adequate equipment available in 2016 to 43,6% in 2023. 10,3% of participants did not know if there was equipment available. In terms of knowledge, there remained poor formal training with a drop from 93% participants identifying that the main indication to attempt emergency cervical reduction was acute cervical dislocation with worsening neurology, to only 46,2%. However, there was an increase in the number of participants who thought reduction was safe. The same percentage of participants from 2016 to 2023 would attempt emergency cervical reduction if given adequate training.Previously we found that most Western Cape hospitals had inadequate protocols, training, and equipment for cervical reductions. In 2023, more hospitals in the Province have protocols in place for cervical reductions and the same percentage of doctors would attempt emergency cervical reduction with adequate training. However, equipment and training for management of acute cervical dislocations has not improved.We conclude that most Western Cape Hospitals are unprepared to adequately manage acute cervical dislocations.

Critical Care Management of Fracture Dislocation of Cervical Spine: A Case Report

Background: Spinal cord injuries affect nearly 1 million people every year, more than 90% of all cervical injuries require intubation, most cases also require tracheostomy, and nearly 40% are ventilator dependent. This study aimed to describe critical care management of fracture dislocation of spine. 
 Case Presentation: A 27-year-old male patient complained patient came with complaints of weakness in both limbs 13 hours before admission. Initially, the patient was driving a motorbike then the patient was involved in an accident with a car after the incident, the patient also felt a bit short of breath, could not move both his leg and hand, and could not feel defecation or urination. Patient was diagnosed with Fracture dislocation of C4-C5. The patient underwent elective decompression stabilization. Patient admitted to ICU with the majority requiring assisted ventilation. After five days in the ICU, the patient was challenged to be released from the ventilator, so the patient was performed early tracheostomy
 Conclusion: Patients with cervical injuries require comprehensive care in the intensive care unit, especially in airway management and respiratory support, in addition to addressing the potentially catastrophic multisystem sequelae of nerve damage.

Atlantoaxial Subluxation with Atlas and Hangman’s Fractures: A Case Report

Combined dislocation and fracture of the upper cervical spine in adults is a rare condition that may result in devastating consequences. With the increase in road traffic accidents and the improvement in prehospital emergency care, serious injuries of the upper cervical spine are more frequently diagnosed at tertiary care centers. We report a case of a 19-year-old adolescent with dislocation-fracture of the upper cervical spine following a moderate-energy trauma. With early diagnosis and treatment, the patient showed good progress without major complications and 24-month follow-up.

Immediate Closed Reduction Technique for Cervical Spine Dislocations.

Retrospective study. This research aimed to assess the clinical outcomes of patients with traumatic cervical spine dislocation who underwent closed reduction employing our approach. Bedside closed reduction is the quickest procedure for repairing traumatic cervical spine dislocations; nevertheless, it also possesses the risk of neurological deterioration. For closed reduction, the patient's head was elevated on a motorized bed, the cervical spine was placed at the midline, traction of 10 kg was applied, the motorized bed was gradually returned to a flat position, the head was lifted off the bed, and the cervical spine was slowly adjusted to a flexed position. The weight of traction was elevated by 5-kg increments until the positional shift was attained. Subsequently, the bed was gradually tilted while traction was applied again to return the cervical spine to the midline position. Of the 43 cases of cervical spine dislocation, closed reduction was carried out in 40 cases, of which 36 were successful. During repositioning, three patients experienced a temporary worsening of their neck pain and neurological symptoms that enhanced when the cervical spine was flexed. Closed reduction was conducted while the patient was awake; nevertheless, sedation was needed in three cases. Among the 24 patients whose pretreatment paralysis had been characterized by American Spinal Injury Association Impairment Scale (AIS) grades A-C, seven patients (29.2%) demonstrated an enhancement of two or more AIS grades at the last observation. Our closed reduction approach safely repaired traumatic cervical spine dislocations.

Efficacy, Safety, and Reliability of the Single Anterior Approach for Subaxial Cervical Spine Dislocation.

Background Though there is ongoing controversy regarding the best treatment option for cervical spine dislocation (CSD), anterior cervical surgery with direct decompression is becoming widely accepted. However, managing all cases of subaxial CSD entirely by a single anterior approach is rarely seen in the published literature. Methods The study comprised patients with subaxial CSD who underwent surgical stabilization utilizing a single anterior approach. Most of the CSD was reduced and anterior cervical discectomy and fusion (ACDF) were performed. Anterior cervical corpectomy and fusion (ACCF) were done in unreduced dislocations. The patient's neurological condition, radiological findings, and functional outcomes were assessed. SPSS version 25.0 (IBM Corp., Armonk, NY) was used for statistical analysis. Results The total number of operated cases was 64, with an average of 42 months of follow-up. The mean age was 34.50±11.92 years. The most prevalent level of injury was C5/C6 (57.7%). Reduction was achieved in 92.2% of cases; only 7.8% of patients needed corpectomy. The typical operative time was 84.25±9.55 minutes, with an average blood loss of 112.12±25.27 ml. All cases except complete spinal cord injury (CSI) were improved neurologically (87.63%). The mean Neck Disability Index (NDI) was 11.14±11.43, and the pre-operative mean visual analog score (VAS) was finally improved to 2.05±0.98 (P<0.05). In all cases, fusion was achieved. The most common complication was transient dysphagia (23.4%). After surgery, no patient developed or aggravated a neurological impairment. Implant failure was not observed at the final follow-up except for two cases where screws were pulled out partially. Conclusion Based on the results of this study, a single anterior approach is a safe and effective procedure for subaxial CSD treatment with favorable radiological, neurological, and functional outcomes.

Motorized Robotic Closed Cervical Traction: Biomechanical Proof of Concept.

Biomechanical study. To demonstrate that robotic cervical traction can apply closed cervical traction as effectively as manual weight-and-pulley traction in extension spring and cadaveric models. Closed cervical traction is used to reduce subaxial cervical spine dislocation injuries and to distract the intervertebral space during cervical spine surgery. Weight-and-pulley cervical traction relies on cumbersome and imprecise technology without any safeguard to prevent over-traction or weights being pulled/released inadvertently. A prototype robotic traction device was designed and manufactured by the authors with real-time tensile force measurement, ±1-lbs (5 N) force application accuracy, locking/non-backdriveable linear actuators with actuator position sensing, 200-lbs (900 N) maximum force capability, up to 20° of flexion/extension manipulation, <25-lbs (111 N) device weight, and compatibility with Gardner-Wells tongs or Mayfield head clamp. The device was tested using an extension spring model and an intact fresh cadaver specimen to assess applied and desired force over time and radiographic changes in the cervical spine as traction force increased. The cadaver was tested in manual traction initially and then robotic traction in 10-lbs (50 N) increments up to 80-lbs (355 N) to compare methods. The prototype device met or exceeded all requirements. In extension spring testing, the device reached the prescribed forces of both 25-lbs (111 N) and 80-lbs (355 N) accurately and maintained the desired weight. In cadaveric testing, radiographic outcomes were equivalent between the prototype and manual weight-and-pulley traction at 80-lbs (355 N; disk space measurements within ±10% for all levels), and the device reached the desired weight within±1-lbs (5 N) of accuracy at each weight interval. This preliminary work demonstrates that motorized robotic cervical traction can safely and effectively apply controlled traction forces.

Awake Early Manual Reduction Is Highly Effective for Subaxial Cervical Spine Dislocation.

Guidelines published in 2013 recommend early closed reduction for cervical spine dislocation. There are two types of closed reduction: manual reduction and traction. Manual reduction can be performed early. In addition, it can correct rotation and requires a short time for complete reduction. We perform manual reduction for cervical spine dislocation. This study aimed to evaluate early manual reduction's success rate and safety for cervical dislocation. We also examined the relationship between time to reduction and improvement in paralysis. This retrospective cohort study included 361 patients with cervical spine injuries treated at our hospital between July 2010 and December 2021. We assigned patients to the early group if the time from injury to reduction was ≤6 hours and to the late group if >6 hours. We performed awake manual reduction on the patients. Furthermore, we compared reduction's success rate and safety, including neurological outcomes. Overall, 46 patients were included in the study: 31 and 15 in the early and late groups, respectively. The success rate of reduction was 93%, and no neurological complications from reduction were observed. The neurological outcomes and reduction success rates were significantly superior in the early group than in the late group. Neurological outcomes were significantly superior when reduction was performed within 6 hours than after 6 hours. Manual reduction can be performed early, safely, and easily. It is effective for cervical spine dislocation requiring early reduction for an excellent neurologic prognosis.

Anterior cervical plating combined with zero-profile anchored spacer for the treatment of cervical facet dislocation in elderly patients

ObjectiveThe purpose of this study was to evaluate the efficacy of anterior cervical plating combined with zero-profile (Z-P) anchored spacer for the treatment of cervical facet dislocation in elderly patients. MethodsThis is a retrospective study. Twelve elderly patients (from 57 to 77 years old, averaged 65 years) with unilateral or bilateral facet dislocation of sub-axial cervical spine from September 2015 to September 2019 surgically treated at the authors’ hospital were enrolled in this study. The patients with osteoporosis or osteopenia were all surgically treated by anterior-only procedure using cervical plating combined with zero-profile anchored spacer after closed manual reduction under general anesthesia and spinal cord monitoring. The operation times (OT), estimated blood loss (EBL), perioperative complications, were recorded. The clinical evaluation included visual analogue scales (VAS) and the American Spinal Injury Association (ASIA) scale. The radiographic evaluation included kyphotic angle (KA) and disc height (DH) and the fusion rate. ResultsAnterior discectomy, interbody fusion and fixation were performed in all patients after the disloctions were reduced by manual maneuver. The average OT was 66 minutes, with a range from 45 to 110 minutes. The EBL averaged 42 ml per surgical procedure, with a range from 20 to 60 ml. The VAS, ASIA, KA were improved significantly after surgery (P<0.05). The average follow-up time was 24.2 months, with a range from 12 to 38 months. There were no statistical differences between the immediately post-op KA and KA at the last follow-up (P>0.05). No disc space subsidence was observed statistically (P<0.05) Interbody fusion was obtained in all patients. Two patient experienced slight difficulty in swallowing, which were improved 6 weeks later. There were no hardware failure, no segmental instability, no wound infection or other complications. ConclusionsManual reduction with spinal cord monitoring under general anesthesia is a safe and efficient option and the anterior cervical plating combined with Z-P spacer could achieve reliable fixation for the patients with cervical facet dislocation in the elderly patients with osteoporosis or osteopenia.

Contiguous-Level Unilateral Cervical Spine Facet Dislocation-A Report of a Less Discussed Subtype.

Unilateral facet dislocation of subaxial cervical spine trauma is characterized by dislocation of inferior facet of superior vertebra over the superior facet of inferior vertebra. The injury is due to high-velocity trauma and associated with instability of spinal column. Such unilateral facet dislocations occurring at multiple adjacent levels for some reason are not reported or studied frequently. We have reported two cases of multiple-level dislocation of unilateral facets managed in our hospital with a review of available literature. The injury occurs as one side of the motion segment translates and rotates around an intact facet on the contralateral side. The major mechanism of injury is distractive flexion injury with axial rotation component. The injury is associated with instability secondary to loss of the discoligamentous complex. In cases with multiple-level dislocations of unilateral cervical facets, there are multiple mechanisms associated with significant neurological injury and most of them succumb at the site of injury. Only three other cases are available in English language literature. The neurological outcome is invariably poor. Multiple-level facet dislocations of subaxial cervical spine are reported sparsely in literature. We suspect that due to high-velocity nature of these injuries, most of them succumb soon after injury and not often reported. This article reports two cases of contiguous-level unilateral facet dislocation of subaxial cervical spine with associated injuries and the outcomes with review of literature.

Nursing Intervention Study of Microscope-assisted Anterior and Posterior Fusion for Lower Cervical Spine Fracture and Dislocation

To explore the nursing intervention measures of microscopy-assisted anterior and posterior fusion in the treatment of lower cervical spine fracture and dislocation.46 patients with fracture and dislocation of lower cervical spine who were treated by microscope-assisted anterior and posterior fusion in our hospital from April 2018 to April 2019 were selected for this study, and divided into observation group and control group according to the different nursing interventions applied by the patients during the treatment. There were 23 patients in the two groups, while the patients in the control group were given routine nursing interventions. The patients in the observation group were given comprehensive nursing interventions. The curative effects of the treatment and nursing interventions in the two groups were observed, sorted out, analyzed and summarized. The changes of psychological status, recovery of spinal cord function, occurrence of complications and quality of life before and after nursing intervention were compared between the two groups.(l) Psychological status: Before nursing intervention, there was no significant difference in psychological status between the two groups, and there was no significant difference (P &gt; 0.05); After nursing intervention, the SDS and SAS scores of patients in the observation group were better than those in the control group, and the difference was statistically significant (P &lt; 0.05); (2) Recovery of spinal cord function: before nursing intervention, there was no significant difference in JOA scores of spinal cord function between the two groups, and the difference was not statistically significant (P &gt; 0.05); After nursing intervention, JOA score of spinal cord function in the observation group was significantly better than that in the control group, the difference was statistically significant (P &lt; 0.05); (3) Complication occurrence: Complication incidence in the observation group was lower than that in the control group, the difference was statistically significant (P &lt; 0.05). (4) Quality of life: before nursing intervention, there was no significant difference in QOL scores between the two groups, and the difference was not statistically significant (P &gt; 0.05); after nursing intervention, the QOL scores of patients in the observation group were better than those in the control group, and the difference was statistically significant (P &lt; 0.05).Through the analysis, it was found that the operation of microscope-assisted anterior and posterior fusion therapy was more complicated and the risk of treatment was greater. The comprehensive nursing interventions throughout the preoperative, intraoperative and postoperative period played a vital role in improving the treatment effect of patients, which was not only conducive to the effective recovery of patients’ spinal cord function. At the same time, it can avoid complications in the treatment process, so as to promote the early recovery of the patient’s condition and improve the quality of life. In general, the application of comprehensive nursing interventions in the treatment of lower cervical spine fracture patients has higher application value, which is worthy of clinical vigorous promotion and.

The impact of helicopter emergency medical services and craniocervical traction on the early reduction of cervical spine dislocation in a rural area of Japan

BackgroundSeveral studies have shown an association between achieving decompression of the spinal cord within a few hours and neurological recovery, even in patients with complete paralysis due to cervical spine dislocation. This study aimed to clarify the impact of helicopter emergency medical services (HEMSs) and craniocervical traction on the rapid reduction of lower cervical spine dislocation in rural Japan. MethodsThe success rate of and factors inhibiting closed reduction, the time from injury to reduction and the functional prognosis of lower cervical spine dislocations treated between July 2012 and February 2020 were retrospectively analysed. ResultsFourteen patients were transported by HEMS (group H), seven by ambulance (group A) and two by themselves. Although the average traveled distance and injury severity score were significantly higher in group H (64.5 km, 28.0) than in group A (24.7 km, 18.6), there was no significant difference in the average time to admission or the time to initiation of craniocervical traction after admission between groups H (159.4 min, 52.2 min) and A (163.6 min, 53.2 min). The success rate of closed reduction was 95%, and neurological deterioration was not observed in any cases. The average traction time and weight for reduction were 30.3 min and 16.3 kg, respectively. Body size and fracture-dislocation type did not significantly affect the traction time or weight. The rate of reduction within 4 h after injury was higher in group H (79%) than in group A (33%). Inner fixations were treated an average of 5.7 days after admission. After treatment, three of nine AIS A patients recovered the ability to walk, and all three patients underwent successful closed reduction within 4 h after injury. ConclusionHEMS and highly successful closed reduction contributed to the early reduction of cervical spine dislocation and can potentially improve complete paralysis.

Treatment of locked lower cervical fracture and dislocation with anterior cervical fusion and internal fixation combined with the release of interlocking facet through the Luschka joint and anterior lamina space

To investigate the effectiveness of treatment of locked lower cervical fracture and dislocation with anterior cervical fusion and internal fixation combined with the release of the interlocking facet through the Luschka joint and anterior lamina space. Twelve patients with lower cervical interlocking fracture and dislocation were analyzed retrospectively between January 2013 and June 2015. There were 7 males and 5 females, aged 25-59 years with an average age of 38.4 years. The disease duration was 9.6 hours to 100 days with an average of 7.3 days. There were 8 cases of unilateral locking and 4 cases of bilateral locking; 4 cases of old injury and 8 cases of fresh injury. The injured segments were 2 cases of C 3, 4, 5 cases of C 4, 5, 3 cases of C 5, 6, and 2 cases of C 6, 7. According to Meyerding classification, there were 9 cases of grade Ⅰ and 3 cases of grade Ⅱ. According to the functional classification of American Spinal Injury Association (ASIA), there were 2 cases of grade C, 6 cases of grade D, and 4 cases of grade E. The interlocking facet was released through the Luschka joint and anterior lamina space, and the anterior cervical fusion and internal fixation were used to treat the fracture and dislocation of the lower cervical spine. The recovery of spinal cord function was judged by the functional classification of ASIA; visual analogue scale (VAS) score, neck disability index (NDI) score, modified Japanese Orthopaedic Association (m-JOA) score were used to evaluate the clinical efficacy; the Cobb angle of fusion segment were observed by X-ray film. The intervertebral bone graft fusion was evaluated at 6 months after operation. The average operation time was 78.30 minutes, the average intraoperative blood loss was 167.30 mL, and the average postoperative drainage volume was 58.12 mL. No blood transfusion was given during or after operation. During the operation, there was no accidental injury of large blood vessels, esophagus, and trachea; no laryngo edema, dysphagia, hoarseness, and cerebrospinal fluid leakage occurred after operation; no spinal cord injury or nerve root injury aggravated; the incision healed by first intention, and no infection occurred. All 12 cases were followed up 15-20 months, with an average of 16.5 months. The symptoms and function of the nerve injury were significantly improved when compared with that before operation. Re-examination of the cervical spine X-ray film at 6 months after operation showed that the Cage or bone graft was not displaced or broken, the screw was not loosened or detached, and the intervertebral graft fusion rate was up to 100%. At last follow-up, the ASIA grade, Cobb angle of fusion segment, neck pain VAS score, m-JOA score, and NDI score were significantly improved when compared with preoperative one ( P<0.05). The effectiveness of treatment of locked lower cervical fracture and dislocation with anterior cervical fusion and internal fixation combined with the release of the interlocking facet through the Luschka joint and anterior lamina space is clear, which not only can make the injured segment get satisfactory reduction, immediate stability and reconstruction, and full decompression, but also can effectively prevent the secondary injury of spinal cord.

Adherence to a standard operating procedure for patients with acute cervical spine dislocations: review of a tertiary, referral, academic hospital in South Africa

ABSTRACT BACKGROUND: To analyse the impact that the adoption of our institutional standard operating procedure (SOP) for cervical spine dislocations had on the timing of closed reduction at our hospital METHODS: The study was a retrospective review of patients who presented to our institution with cervical dislocation injuries and who were managed with closed reduction. The patient records of acute cervical spine dislocations from 2015 to 2018, data from the Acute Spinal Cord Injury database along with patient's demographic information were gathered and compared. Participants within the study time frame were diagnosed with a cervical facet dislocation based on clinical examination findings and radiological confirmation. Patients who had reduction performed at other referring hospitals were excluded from the study. RESULTS: The practice within all tertiary hospitals in the Western Cape is to perform closed reduction of cervical fracture dislocations as soon as possible after injury. In this study the time between injury and closed reduction before introducing the SOP was 13 h 13 min and after introducing the SOP, the time increased to an average of 14 h 28 min. The main cause of delay was the transfer time from the site of injury to the emergency ward. Other reasons for the delay include missed diagnosis, orthopaedic registrar unavailability and incomplete reduction bed CONCLUSION: This study found that the time taken for orthopaedic management of cervical dislocations increased by an hour after introduction of the SOP. Additionally, the overall time to reduction also increased. This was due to delays in transfer to the emergency ward and referral to Orthopaedics. We recommend that, in our setting, reduction could be initiated within an hour of patient arrival, if emergency ward doctors rapidly identified the problem and commenced cervical traction when the orthopaedic team was not immediately available. Our impression was that there was poor adherence to the new SOP guidelines on time management by the trauma team, and possibly transport delays prior to hospital admission. A further study to investigate the bottlenecks of the referral system is advisable Level of evidence: Level 4 Keywords: acute outcomes, cervical spine, dislocation injuries

Always Carefully Evaluate the Atlanto-Axial Rotatory Subluxation in Children. One Case Report Presentation

Background: Atlanta-Axial Rotatory Subluxation is an acquired condition, usually occurring in paediatric patients, because of either trauma or pharyngitis or ear-nose-throat (ENT) surgery or upper respiratory tract infection. Post-traumatic C1-C2 rotational subluxation in paediatric age is a very frequent event. It mimics benign torticollis but may result in permanent disability. The Atlanta-axial rotatory displacement, as defined initially by Fielding and Hawkins in 1977, is classified into four types: Type 1 is the most common form in children. It is a simple rotatory displacement without an anterior shift. Type 2 is potentially more dangerous. It is a rotatory displacement with an anterior shift of 5 mm or less. Type 3 is rotatory displacement with an anterior shift greater than 5 mm. Finally, type 4 is rotatory displacement with a posterior shift. Type 3 and 4 deformities are rare, but neurological involvement or even instant death may follow [Figure. 4] [18]. The condition requires prompt diagnosis by thorough examination to avoid any treatment delays. The difficulties for a timely and correct diagnosis and then the correct treatment is described. Case presentation: A 5-year-old girl comes to the emergency room with cervical pain and stiffness. This painful state, as mum reports, has been lasted for about ten days, after a mild trauma. The radiographic picture demonstrates a rotary subluxation C1-C2, type 1 according to Fielding and Hawkins classification. The treatment is head-halter traction with 2kg, and nonsteroidal anti-inflammatory drugs (NSAIDs). After 2 days the x-ray picture improves, but the painful symptoms persist. An in-depth diagnostic MRI of the cervical spine and brain revealed a medulloblastoma which made an immediate and effective neurosurgical intervention necessary. Conclusions: the C1-C2 rotatory dislocation must always be evaluated with extreme care, without neglecting any clinical and anamnestic information for a correct and timely differential diagnosis. Remember that children show very clearly what they feel, always. Keywords: AARS; Cervical spine dislocation; Rotatory subluxation; Differential diagnosis; Medulloblastoma