Objectives: To perform an analysis of the surgical approach choice in subaxial cervical spine (SCS) facet dislocations.
Methods: The inclusion criteria were as follows: radiologically confirmed traumatic SCS facet dislocation, 18 - 70 years of age, stable medical condition, and isolated cervical trauma. The management scheme was based on the presence of traumatic disc herniation (TDH) and the grade of dislocation according to Allen and Ferguson Classification (AFC). In the absence of TDH, the reduction was attempted via traction under general anesthesia before surgery. In the presence of TDH, the reduction was attempted after anterior discectomy. Posterior open reduction was performed in case of an unsuccessful reduction attempt. Anterior stabilization was sufficient in AFC distractive flexion stage (DFS) 2 fractures while combined stabilization was performed in DFS 3 and 4 fractures.
Results: Thirty-two patients were included in the study. TDH was detected in 14 patients. The number of patients with DFS 2, 3, and 4 fractures was 6, 18, and 8, respectively. Posterior open reduction was needed in 9 patients. Anterior stabilization was performed in 6 patients (3 with TDH, 3 without TDH) and combined stabilization was performed in 26 patients (11 with TDH, 15 without TDH) via 6 anterior, 7 anterior-posterior, 15 posterior-anterior, and 4 anterior-posterior-anterior approaches. Satisfying improvement was achieved in radiological and neurological evaluations, and neck pain scores.
Conclusions: The treatment algorithm for facet dislocations based on DFS and TDH presence provided satisfactory results.
Key words: subaxial cervical spine, facet dislocation fracture, traumatic disc herniation, Allen and Ferguson Classification, decision-making, Subaxial Injury Classification (SLIC) and Severity Scale
|
