Posterior Open Reduction Research Articles

Treatment of cervical dislocation with locked facets

Lower cervical dislocation with locked facets is common in cervical injury. The locked facets include unilateral and bilateral types. Different successful closed reduction rates has been achieved between unilateral and bilateral types by using rapid skull traction, which was commonly used to reduce the cervical dislocation. It is important to investigate a suitable management specific to patients with different types of cervical locked facets. A total of 38 patients with cervical dislocation with locked facet due to cervical injury treated by rapid skull traction and operation from 1988 to 2005 were reviewed. Rapid skull traction was used in all the patients. Successful closed reduction rate was 88.0% in patients with bilateral cervical locked facets and that was 15.4% in those with unilateral cervical locked facets. These data were then statistically compared by Chi-square test. Patients who were reduced successfully underwent anterior cervical discectomy and fusion at the injured level, and those who failed in closed reduction received posterior open reduction and fixation. In this series, there was statistically significant difference (P < 0.05) in the rate of successful closed skull traction reduction between unilateral and bilateral locked facets dislocation. Unilateral cervical locked facets dislocation was not easily reduced by skull traction which was suitable for reduction of bilateral cervical locked facets dislocation. However, unilateral cervical locked facets dislocation can be reduced by posterior open reduction. Unilateral cervical locked facets dislocation should be treated immediately with posterior open reduction and instrumentation. Bilateral cervical locked facets dislocation can be reduced by rapid skull traction firstly and anterior cervical discectomy and interbody fusion later.

The Management of Bilateral Interfacetal Dislocation with Anterior Fixation in Cervical Spine : Comparison with Combined Antero-Posterior Fixation

Combined antero-posterior fixation has been a standard method for bilateral interfacetal dislocation in cervical spine. The purpose of this study is to evaluate the efficacy and complication of anterior cervical stabilization in treatment of bilateral interfacetal dislocation. A total of 65 cases of traumatic bilateral interfacetal dislocation in cervical spine who were managed in our institution, from Mar. 1997 to Feb. 2006, were included in this study. Closed reduction was tried in all cases before operation. If closed reduction was accomplished successfully, only anterior cervical fixation was performed (Group I), and attempted to place screws bicortically as possible with unicortical screws. If failed, posterior open reduction with fixation was first tried, followed by anterior cervical fixation (Group II). All patients were evaluated for neurological outcome and radiological evidence of healing. The Group I included 47 patients and the Group II, 18 patients. The improvement of Frankel grade and increase of mean cervical lordosis angles were not statistically different between two groups. Screw-plate system used did not influence the outcome. On follow up, solid bone fusion was evident and there were no cases of instability in both groups. Our study demonstrated that anterior cervical fixation on BID is safe and effective in comparison with combined antero-posterior cervical fixation.

Paediatric spinal trauma and associated injuries

Paediatric spinal injuries, although rare (1-2% of all paediatric fractures) are associated with the highest mortality rate of all orthopaedic injuries in children. The low incidence is due, not only to the plasticity of the paediatric spine, but also the difficulty of diagnosis and the usually severe if not fatal associated injuries. A 10-year (1995-2004) retrospective study was undertaken of all patients treated for a spinal injury at our institute, which functions as both an acute care centre and a tertiary referral centre for seriously injured children. The study was performed in order to highlight the unique features of spinal injuries in children, and to assess the incidence and pattern of associated injuries. A total of 40 patients had a documented diagnosis of spinal injury. The charts and radiographs of all patients were retrieved and reviewed. The median age was 10 years (range 2-15) and 25 were male. The causative factors were motor vehicle accidents in 16, falls in 14, sport injuries in 7 and assaults in 3. Over 65% of the children sustained one or more associated injuries, the mean injury severity score was 18.95. There were two deaths, both in patients with severe multiple trauma and associated spinal fracture. Treatment included closed reduction in two patients and posterior open reduction and stabilisation in two patients, with one of these also requiring decompression. Spinal injuries in children differ from adults due primarily to the biomechanical and anatomical features of the developing musculoskeletal system. When a spinal injury is identified on initial radiographic or clinical evaluation of an injured child, one should have a high index of suspicion that concurrent, potentially life-threatening injuries may be present.

Posterior Instrumentation of the Cervical Spine Using the Neon Occipito-Cervical System

Posterior cervical and cervicothoracic stabilization, if necessary, in combination with posterior spondylodesis, after closed or open reduction as well as with or without neural decompression as clinically indicated. Instabilities and deformities of rheumatoid, traumatic, neoplastic, infectious, iatrogenic or congenital origin. Multilevel cervical spinal stenosis with degenerative instability or kyphosis of the affected spinal segment. Corrective spondylodesis for posttraumatic or postinfectious kyphosis. Infection in the operative field. Inability to undergo anesthesia. Prone position, rigid head fixation, e. g., with Mayfield tongs. If appropriate, closed reduction under lateral image intensification. Midline posterior surgical approach at the level of the segment to be instrumented. If necessary, open reduction. Insertion of the cervical/upper thoracic screws. If necessary, posterior decompression. Instrumentation with prebent longitudinal rods. If a fusion is to be obtained, decortication of the posterior bone elements with a burr and onlay of cancellous bone. 44 patients, 13 women and 31 men, with an average age of 57 years were operated on between August 2000 and August 2003. All patients underwent a follow-up examination 4-39 months (average 15.7 months) after the initial surgery. Fusion was achieved in all patients who had undergone a posterior spondylodesis: no implant failure, no implant removal or reoperation. The preoperatively planned instrumentation could be implemented intraoperatively in all patients.

Stabilization of posterior pelvic injury

Injuries that result in mechanical disruption of the posterior pelvis are often the source of chronic pain and impairment. Advancements of the last 2 decades have increased our understanding of the natural history of these injuries as well as the inherent risk and benefits of surgical treatment. This article presents an overview of the relative merits of anterior open reduction, posterior open reduction, and percutaneous treatment of posterior pelvic ring disruption. Surgical techniques are highlighted and a treatment algorithm is provided for assistance in decision making with these complex injuries.

Major Cervical Spine Injuries in Children and Adolescents

A population-based study of pediatric cervical spine trauma in the Auckland region over 7 years starting in March 1989 identified 32 patients younger than 15 years of age who sustained a fracture, dislocation, or major ligamentous injury including SCIWORA (spinal cord injury without radiographic abnormality). Thirty-one percent had associated injuries and 53% had abnormal neurologic findings on presentation. Children younger than 10 years of age with cervical spine trauma more commonly sustained the injury in a motor vehicle accident and had a preponderance of injuries of the upper cervical spine. Children 10 years of age or older were more often injured during sport or recreational activity and the injuries followed a more typically adult pattern. Treatment included closed reduction in two patients and posterior open reduction and stabilization in eight patients (25%) with one of these also requiring decompression. All patients treated surgically had a very satisfactory outcome.

Supracondylar fractures of the humerus in childhood: range of movement following the posterior approach to open reduction

The posterior approach for open reduction of supracondylar fractures of the humerus has been condemned for causing decreased elbow movement. This study investigates this by comparing the range of movement in children treated by posterior open reduction and Kirschner wiring with those treated by closed reduction and immobilization. A total of 65 children with severely displaced supracondylar humeral fractures have been reviewed. There was some loss of movement in 66 per cent of the open reduction group and 42 per cent of the closed reduction group. The proportion losing more than 10 ° of movement was the same in both groups. The difference between the two groups was due to the increased numbers in the open reduction group who lost less than 10 ° of motion. Posterior open reduction of childhood supracondylar fractures is not associated with an important loss of elbow movement and need not be avoided on this account.

Surgical stabilization of the cervical spine after trauma.

Surgical stabilization should be individualized for each patient. The procedure used should provide both immediate and prolonged stability at the site of instability. The choice of procedure depends on knowledge of the structures providing stability and of the mechanism of injury. Pure flexon injuries without comminution or disruption of ligaments are stable and do not require surgical treatment. Flexion-rotation dislocations, with either unilateral or bilateral facet dislocation, should be treated by posterior open reduction and fusion if they cannot be reduced by a closed method or if there is demonstratable motion on three-month flexion-extension roentgenograms. A comminuted burst ("teardrop") fracture produced by axial loading of the vertebral bodies should be stabilized by an anterior cortical strut graft for early mobilization and realignment of the spinal column to prevent progressive deformity.