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A novel anterior-only surgical approach for reduction and fixation of cervical facet dislocation.

Research paper by Ke K Liu, Zhengfeng Z Zhang

Indexed on: 05 Sep '19Published on: 29 Apr '19Published in: World Neurosurgery



Abstract

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 has a reduction failure rate of up to 40%. When it fails, a posterior approach is usually required. To report a novel anterior-only surgical approach for reduction and fixation in patients with cervical facet dislocation, even for severe vertebral fracture, articular process fracture and delayed surgical management. Sixty-three consecutive patients with unilateral/bilateral facet dislocation of the subaxial cervical spine were treated with this anterior-only procedure. After discectomy, kyphotic paramedian distraction reduction with Caspar pins plus vertebral screw plate fixation were performed. If the reduction failed, anterior facetectomy reduction plus anterior cervical pedicle screw plate fixation were introduced. Among the 63 patients treated, 52 patients achieved successful reduction using the technique of kyphotic paramedian distraction with Caspar pins; the remaining 11 patients with failure of the former technique saw successful reduction using the anterior facetectomy technique. No supplemental posterior approach surgery was performed. The American Spinal Injury Association (ASIA) grade was improved by at least one grade in 23 patients after this procedure, and no neurologic deterioration occurred in any of the patients. After at least 12 months of follow-up, all patients achieved satisfactory fusion, and there was no implant failure. An anterior-only surgical procedure including kyphotic paramedian distraction with Caspar pins, anterior facetectomy and anterior pedicle screw plate fixation is safe and effective for subaxial cervical facet dislocations. Copyright © 2019 Elsevier Inc. All rights reserved.