Reduction Of Cervical Facet Dislocations Research Articles

Reduction of Lower Cervical Facet Dislocation: A Review of All Techniques.

The surgical treatment of lower cervical facet dislocation is controversial. Great advancements on reduction techniques for lower cervical facet dislocation have been made in the past decades. However, there is no article reviewing all the reduction techniques yet. The aim is to review the evolution and advancements of the reduction techniques for lower cervical facet dislocation. The application of all reduction techniques for lower cervical facet dislocation, including closed reduction, anterior-only, posterior-only, and combined approach reduction, is reviewed and discussed. Recent advancements on the novel techniques of reduction are also described. The principles of various techniques for reduction of cervical facet dislocation are described in detail. All reduction techniques are useful. The anterior-only surgical approach appears to be the most popular approach. Moreover, many novel or modified reduction and fixation methods have been introduced in recent years. The selection of surgical approach depends on a combination of factors, including surgeon preference, patient factors, injury morphology, and inherent advantages and disadvantages of any given approach.

Awake Cranial Traction and Isolated Anterior Cervical Discectomy and Fusion in the Treatment of Traumatic Subaxial Cervical Facet Joint Dislocations: Analysis of a Cohort of 70 Patients and Predictors of Surgical Failure.

Cervical facet dislocations are among the most common traumatic spinal injuries. The management of this type of lesions is still controversial. The objective of the present study was to analyze the results of subaxial cervical facet dislocations submitted to an isolated anterior cervical discectomy and fusion (ACDF) after attempted closed reduction with cranial traction and to identify risk factors for treatment failure. All patients who were operated on in a tertiary trauma center during an 11-year period (2008-2018) for traumatic single-level cervical facet joint dislocation (AO C F4 injuries) were retrospectively reviewed. Age, use of cranial traction, dislocation characteristics, neurologic injury, surgical data, and follow-up records were reviewed. A minimum of 18 months follow-up was required. A total of 70 patients with a mean age of 56 years (18-90) (72% men) were identified. The C6-C7 level was the most frequently affected (36/70 cases). Spinal cord injury (SCI) was present in 34% of the cases. Bilateral dislocations and rigid spines were risk factors for SCI. Cranial traction was performed in 59 cases with success in 52 cases (88%). There were 3 failures after anterior fusion, which required revision surgery with a 360° fusion, all occurring at the C7-T1 level. Cranial traction of the cervical spine is an effective and fast way to achieve closed reduction of cervical facet dislocations. After successful reduction, ACDF, as a single procedure, offers an excellent surgical option. All cases of failure occurred at the C7-T1 level, suggesting that a 360° fusion may be needed at this level.

Closed traction reduction of cervical spine facet dislocations: Compelled by law

Background. Following a 2015 ruling, the South African (SA) Constitutional Court obligates closed reduction of cervical facet dislocations sustained through low-energy injury mechanisms, within 4 hours of injury. Closed traction reduction of cervical facet dislocations requires specific equipment and expertise, which have limited availability in SA. Objectives. To review the time delays, delaying factors and success rate of closed reductions of cervical facet dislocations in a tertiary-level orthopaedic department and training facility, and to consider the feasibility of such a reduction within 4 hours after injury. Methods. The clinical records and imaging screens of patients presenting with cervical facet dislocations to an academic training hospital between November 2008 and March 2016 were retrospectively reviewed, with specific attention to demographic information, mechanism of injury, time delays from injury to treatment and factors resulting in delay, as well as the success rate in closed cervical reduction. Results. Ninety-one patients with cervical dislocation presented during the study period, of whom 69 were included for further review. The mean age at presentation was 37.6 (range 18 - 65) years. Successful reduction was achieved in 71% ( n =49) of cases, with a median delay time from injury to reduction of 26 (interquartile range (IQR) 19.50 - 31.75) hours. Only 1 patient of 69 patients received successful reduction within 6 hours after injury. Neurological improvement was noticed in 5 of 53 patients with neurological deficit – after successful reduction. Two patients improved with two American Spinal Injury Association (ASIA) grades (from A to C), and 2 improved with one ASIA grade (from A to B and D to E). Conclusions. Successful reduction of a cervical facet dislocation within 4 hours presents a challenge to healthcare infrastructure globally. The relative scarcity of this type of injury (91 cases during 8 years in a tertiary referral hospital) prevents district-level clinicians from readily acquiring a level of experience to confidently perform closed reduction of these injuries, unless very specific training and support are provided towards this end.

Early versus delayed reduction of cervical spine dislocation with complete motor paralysis: a multicenter study.

Reduction of cervical facet dislocation should be performed as soon as possible to depressurize neuron cells although some randomized control studies defined early reduction as over 24h after trauma. The purpose of this study was to define the actual time limit for early reduction in patients with complete motor paralysis. Cervical spine dislocation patients with complete motor paralysis admitted between April 2007 and December 2014 were analyzed as retrospective cohort study. We separated the patients into three groups according to the number of hours lapsed between the trauma and reduction, within 4h (very early group), >4-6h (early group), and >6h (delayed group). We compared the neurological outcomes, patient injury patterns, the arrival time at the hospital, and the injury severity score (ISS). Of 30 patients who enrolled, 8 (27%) were recovered to American Spinal Injury Association Impairment Scale Grades C-E. The delayed group had poorer neurological outcomes than the very early group and early group, although no significant differences were noted in the recovery rate between the very early group and early groups. The injury pattern, arrival time, and ISS were not found to be associated with the neurological outcome. Our data suggest that early (<6h) reduction of cervical spine dislocation is associated with favorable neurological outcome as compared with those performed after 6h.

Anterior Facetectomy for Reduction of Cervical Facet Dislocation.

Technique report and case series. The aim of this study was to develop a new surgical technique for anterior reduction in management of unilateral/bilateral facet dislocations and to report the results of 8 patients with successful outcomes associated with this approach. The anterior-only surgical procedure, including discectomy, open reduction, fusion, and fixation, is a recommended approach in the treatment of cervical facet dislocations. This approach is with a failure rate of up to 40%. When it fails, a posterior approach is usually required. We have developed a new surgical approach with facetectomy for anterior reduction of cervical facet dislocations. This technique is especially useful for delayed management of unilateral/bilateral facet dislocation patients who failed the conventional anterior open reduction to avoid a posterior procedure. Eight patients with cervical facet dislocations who failed in the conventional anterior reduction were surgically treated by the anterior facetectomy reduction technique. After discectomy, anteromedial foraminotomy was performed by resection of posterior foraminal part or total of uncovertebral joint. After the nerve root was retracted cephalad in the neuroforamina, the edge of the dislocated superior facet was broken to achieve reduction. Postoperatively, all patients have obtained successful reduction and satisfactory anatomic sagittal alignment. There were no complications attributable to the use of this technique. Anterior facetectomy reduction represents a safe and efficacious but technically challenging option for the treatment of cervical facet dislocation. 5.

Bilateral Facet Dislocation with Neural Compression from an Avulsed Posterior Longitudinal Ligament

Background and Importance: A review of the literature failed to show evidence of normal appearing posterior longitudinal ligament avulsion as a cause of spinal cord compression after bilateral cervical facet dislocations. We report a case of the posterior longitudinal ligament (PLL) avulsion causing spinal cord compression after bilateral cervical facet dislocation. Clinical presentation: A 93 year female presented with upper extremity numbness and bilateral C5-C6 facet dislocations. The patient was immediately taken for closed reduction and anterior cervical decompression with fusion (ACDF). After awake, closed reduction, an ACDF was immediately performed. After a complete discectomy procedure, the spinal cord could be visualized secondary to an absent PLL. A nerve hook was used to explore behind the C6 vertebral body to decompress the spinal cord. A segment of normal appearing posterior longitudinal ligament, which had avulsed from the superior aspect of C5, was found folded behind the C6 vertebra causing cord compression. There was no herniated disk material discovered. Conclusion: In addition to herniated disk material, avulsed PLL is another potential source of cord compression after closed reduction of cervical facet dislocations and surgeons must be aware of this possible source of compression while exploring and decompressing the spinal canal. This case study elucidates that the PLL is a potential cause of spinal cord compression after traumatic bilateral cervical facet dislocations.

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.

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.

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.

Intraoperative reduction of locked facets in the cervical spine by use of a modified interlaminar spreader: technical note.

Facet dislocations commonly require intraoperative reduction after closed reduction with traction has failed. Reduction should be performed in a gradual, controlled fashion to prevent additional inadvertent spinal cord compromise. We describe a new technique for safe and simple dorsal reduction of facet dislocations by use of a modified interlaminar spreader. This technique requires only minimal controlled manipulation of the spine. We have used this technique in 52 consecutive patients with no complications or failures related to its use in open reduction. This technique increases the stability of the cervical spine after reduction because it limits bone removal from the facet joints. This technique provides a feasible and reliable approach to open reduction of cervical facet dislocations via the posterior approach.