Anterior Reduction and Fusion of Cervical Facet Dislocations

Christian B. Theodotou, George M. Ghobrial, Andrew L. Middleton, Michael Y. Wang, Allan D Levi

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

BACKGROUND: Cervical facet dislocations are among the most common traumatic spinal injuries. Posterior, anterior, and combined surgical approaches have been described and are widely debated. OBJECTIVE: To demonstrate efficacy in anterior-only surgical management for subaxial cervical facet dislocations. METHODS: A consistent surgical algorithm for cervical facet dislocation was applied over a 19-yr period and analyzed retrospectively in adults with acute unilateral or bilateral facet dislocation of the subaxial cervical spine. The primary endpoint was maintenance of early cervical alignment. The need for additional posterior instrumented fusion was determined. RESULTS: A database search identified 96 patients (mean age = 37.9, range = 14-74 yr, 68 (70%) male. The most common affected levels were C4-C5 (30), C5-C6 (29), and C6-C7 (30). Bilateral dislocation occurred in 51 patients (53%). Seventy-eight (81%) patients had neurological deficits, 31 (32%) being complete (Abbreviated Injury Score A) spinal cord injuries. Preoperative closed reduction was attempted in 60 (63%) patients, with 33 (55%) achieving satisfactory alignment. After anterior cervical discectomy, reduction, allograft placement, and instrumentation, a total of 92 (96%) patients had achieved satisfactory realignment. Median time to surgery was 13.27 h. Eight (8%) patients required posterior fixation due to intraoperative determination of incomplete realignment (4; 4%) and development of early progressive deformity (4; 4%). Mean follow-up was 4.5 mo (range 0.5-24 mo) with 33 (34%) patients lost to follow-up. CONCLUSION: Anterior approaches are viable for reduction and stabilization of cervical facet dislocations. Further prospective studies are required to evaluate clinical and long-term success.

Original languageEnglish (US)
Pages (from-to)388-395
Number of pages8
JournalNeurosurgery
Volume84
Issue number2
DOIs
StatePublished - Feb 1 2019

Fingerprint

Diskectomy
Spinal Injuries
Lost to Follow-Up
Spinal Cord Injuries
Allografts
Spine
Maintenance
Databases
Prospective Studies
Wounds and Injuries

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Theodotou, C. B., Ghobrial, G. M., Middleton, A. L., Wang, M. Y., & Levi, A. D. (2019). Anterior Reduction and Fusion of Cervical Facet Dislocations. Neurosurgery, 84(2), 388-395. https://doi.org/10.1093/neuros/nyy032

Anterior Reduction and Fusion of Cervical Facet Dislocations. / Theodotou, Christian B.; Ghobrial, George M.; Middleton, Andrew L.; Wang, Michael Y.; Levi, Allan D.

In: Neurosurgery, Vol. 84, No. 2, 01.02.2019, p. 388-395.

Research output: Contribution to journalArticle

Theodotou, CB, Ghobrial, GM, Middleton, AL, Wang, MY & Levi, AD 2019, 'Anterior Reduction and Fusion of Cervical Facet Dislocations', Neurosurgery, vol. 84, no. 2, pp. 388-395. https://doi.org/10.1093/neuros/nyy032
Theodotou CB, Ghobrial GM, Middleton AL, Wang MY, Levi AD. Anterior Reduction and Fusion of Cervical Facet Dislocations. Neurosurgery. 2019 Feb 1;84(2):388-395. https://doi.org/10.1093/neuros/nyy032
Theodotou, Christian B. ; Ghobrial, George M. ; Middleton, Andrew L. ; Wang, Michael Y. ; Levi, Allan D. / Anterior Reduction and Fusion of Cervical Facet Dislocations. In: Neurosurgery. 2019 ; Vol. 84, No. 2. pp. 388-395.
@article{778201932fb148ffbc4b8d8d711b256a,
title = "Anterior Reduction and Fusion of Cervical Facet Dislocations",
abstract = "BACKGROUND: Cervical facet dislocations are among the most common traumatic spinal injuries. Posterior, anterior, and combined surgical approaches have been described and are widely debated. OBJECTIVE: To demonstrate efficacy in anterior-only surgical management for subaxial cervical facet dislocations. METHODS: A consistent surgical algorithm for cervical facet dislocation was applied over a 19-yr period and analyzed retrospectively in adults with acute unilateral or bilateral facet dislocation of the subaxial cervical spine. The primary endpoint was maintenance of early cervical alignment. The need for additional posterior instrumented fusion was determined. RESULTS: A database search identified 96 patients (mean age = 37.9, range = 14-74 yr, 68 (70{\%}) male. The most common affected levels were C4-C5 (30), C5-C6 (29), and C6-C7 (30). Bilateral dislocation occurred in 51 patients (53{\%}). Seventy-eight (81{\%}) patients had neurological deficits, 31 (32{\%}) being complete (Abbreviated Injury Score A) spinal cord injuries. Preoperative closed reduction was attempted in 60 (63{\%}) patients, with 33 (55{\%}) achieving satisfactory alignment. After anterior cervical discectomy, reduction, allograft placement, and instrumentation, a total of 92 (96{\%}) patients had achieved satisfactory realignment. Median time to surgery was 13.27 h. Eight (8{\%}) patients required posterior fixation due to intraoperative determination of incomplete realignment (4; 4{\%}) and development of early progressive deformity (4; 4{\%}). Mean follow-up was 4.5 mo (range 0.5-24 mo) with 33 (34{\%}) patients lost to follow-up. CONCLUSION: Anterior approaches are viable for reduction and stabilization of cervical facet dislocations. Further prospective studies are required to evaluate clinical and long-term success.",
author = "Theodotou, {Christian B.} and Ghobrial, {George M.} and Middleton, {Andrew L.} and Wang, {Michael Y.} and Levi, {Allan D}",
year = "2019",
month = "2",
day = "1",
doi = "10.1093/neuros/nyy032",
language = "English (US)",
volume = "84",
pages = "388--395",
journal = "Neurosurgery",
issn = "0148-396X",
publisher = "Lippincott Williams and Wilkins",
number = "2",

}

TY - JOUR

T1 - Anterior Reduction and Fusion of Cervical Facet Dislocations

AU - Theodotou, Christian B.

AU - Ghobrial, George M.

AU - Middleton, Andrew L.

AU - Wang, Michael Y.

AU - Levi, Allan D

PY - 2019/2/1

Y1 - 2019/2/1

N2 - BACKGROUND: Cervical facet dislocations are among the most common traumatic spinal injuries. Posterior, anterior, and combined surgical approaches have been described and are widely debated. OBJECTIVE: To demonstrate efficacy in anterior-only surgical management for subaxial cervical facet dislocations. METHODS: A consistent surgical algorithm for cervical facet dislocation was applied over a 19-yr period and analyzed retrospectively in adults with acute unilateral or bilateral facet dislocation of the subaxial cervical spine. The primary endpoint was maintenance of early cervical alignment. The need for additional posterior instrumented fusion was determined. RESULTS: A database search identified 96 patients (mean age = 37.9, range = 14-74 yr, 68 (70%) male. The most common affected levels were C4-C5 (30), C5-C6 (29), and C6-C7 (30). Bilateral dislocation occurred in 51 patients (53%). Seventy-eight (81%) patients had neurological deficits, 31 (32%) being complete (Abbreviated Injury Score A) spinal cord injuries. Preoperative closed reduction was attempted in 60 (63%) patients, with 33 (55%) achieving satisfactory alignment. After anterior cervical discectomy, reduction, allograft placement, and instrumentation, a total of 92 (96%) patients had achieved satisfactory realignment. Median time to surgery was 13.27 h. Eight (8%) patients required posterior fixation due to intraoperative determination of incomplete realignment (4; 4%) and development of early progressive deformity (4; 4%). Mean follow-up was 4.5 mo (range 0.5-24 mo) with 33 (34%) patients lost to follow-up. CONCLUSION: Anterior approaches are viable for reduction and stabilization of cervical facet dislocations. Further prospective studies are required to evaluate clinical and long-term success.

AB - BACKGROUND: Cervical facet dislocations are among the most common traumatic spinal injuries. Posterior, anterior, and combined surgical approaches have been described and are widely debated. OBJECTIVE: To demonstrate efficacy in anterior-only surgical management for subaxial cervical facet dislocations. METHODS: A consistent surgical algorithm for cervical facet dislocation was applied over a 19-yr period and analyzed retrospectively in adults with acute unilateral or bilateral facet dislocation of the subaxial cervical spine. The primary endpoint was maintenance of early cervical alignment. The need for additional posterior instrumented fusion was determined. RESULTS: A database search identified 96 patients (mean age = 37.9, range = 14-74 yr, 68 (70%) male. The most common affected levels were C4-C5 (30), C5-C6 (29), and C6-C7 (30). Bilateral dislocation occurred in 51 patients (53%). Seventy-eight (81%) patients had neurological deficits, 31 (32%) being complete (Abbreviated Injury Score A) spinal cord injuries. Preoperative closed reduction was attempted in 60 (63%) patients, with 33 (55%) achieving satisfactory alignment. After anterior cervical discectomy, reduction, allograft placement, and instrumentation, a total of 92 (96%) patients had achieved satisfactory realignment. Median time to surgery was 13.27 h. Eight (8%) patients required posterior fixation due to intraoperative determination of incomplete realignment (4; 4%) and development of early progressive deformity (4; 4%). Mean follow-up was 4.5 mo (range 0.5-24 mo) with 33 (34%) patients lost to follow-up. CONCLUSION: Anterior approaches are viable for reduction and stabilization of cervical facet dislocations. Further prospective studies are required to evaluate clinical and long-term success.

UR - http://www.scopus.com/inward/record.url?scp=85060039875&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85060039875&partnerID=8YFLogxK

U2 - 10.1093/neuros/nyy032

DO - 10.1093/neuros/nyy032

M3 - Article

VL - 84

SP - 388

EP - 395

JO - Neurosurgery

JF - Neurosurgery

SN - 0148-396X

IS - 2

ER -