Delayed management of traumatic bilateral cervical facet dislocation: surgical strategy

2002 ◽  
Vol 97 (3) ◽  
pp. 362-365 ◽  
Author(s):  
Ronald H. M. A. Bartels ◽  
Roland Donk
Keyword(s):  
Operating Time ◽  
Posterior Fixation ◽  
Neurological Damage ◽  
Cervical Spine Instability ◽  
Content Type ◽  
Facet Dislocation ◽  
Second Stage ◽  
Cervical Facet ◽  
Posterior Anterior ◽  
Anterior Posterior

✓ Postinjury cervical spine instability typically requires surgical treatment in the acute or semiacute stage. The authors, however, report on three patients with older (> 8 weeks) untreated bilateral cervical facet dislocation. In two patients they attempted a classic anterior-posterior-anterior approach but failed. The misalignment in the second stage of the procedure could not be corrected, and they had to add a fourth, posterior, stage. To avoid the fourth stage, thereby reducing operating time and risk of neurological damage while turning the patient, they propose the following sequence: 1) a posterior approach to perform a complete facetectomy bilaterally with no attempt to reduce the dislocation; 2) an anterior microscopic discectomy with reduction of the dislocation and anterior fixation; and 3) posterior fixation. This sequence of procedures was successfully performed in the third patient. Based on this experience, they suggest that in cases of nonacute bilateral cervical facet dislocations the operating sequence should be posterior-anterior-posterior.

Cervical facet dislocation: techniques for ventral reduction and stabilization

2000 ◽  
Vol 92 (1) ◽  
pp. 18-23 ◽  
Author(s):  
Bernardo J. Ordonez ◽  
Edward C. Benzel ◽  
Sait Naderi ◽  
Simcha J. Weller
Keyword(s):  
Cervical Spine ◽  
Surgical Approach ◽  
Plate Fixation ◽  
Neurological Status ◽  
Content Type ◽  
Facet Dislocation ◽  
Cord Injury ◽  
Complete Spinal Cord Injury ◽  
Cervical Facet ◽  
Fine Print

Object. To demonstrate the safety and utility of one surgical approach, the authors reviewed their experience with the ventral surgical approach for decompression, reduction, and stabilization in 10 patients with either unilateral or bilateral cervical facet dislocation. Methods. Six patients presented with unilateral cervical facet dislocation and four patients with bilateral cervical facet dislocation. There were six male and four female patients who ranged in age from 17 to 72 years (average 37.1 years). The level of facet dislocation was C4–5 in one, C5–6 in four, and C6–7 in five patients. Three patients presented with a complete spinal cord injury (SCI), three patients with an incomplete SCI, three with radicular symptoms or myeloradiculopathy, and one patient was neurologically intact. All patients underwent plain radiography, magnetic resonance imaging, and computerized tomography evaluation of the cervical spine. All patients had sustained significant ligamentous injury with minimum or no bone disruption. All patients underwent ventral decompressive surgery, reduction of the dislocation, and stabilization of the cervical spine. Techniques for performing ventral reduction of unilateral or bilateral cervical facet dislocation are described. Decompression, reduction, and stabilization of the cervical spine via the ventral approach was accomplished in all but one patient. This patient underwent a ventral decompressive procedure and an attempt at ventral reduction and subsequent dorsal reduction and fusion in which a lateral mass screw plate fixation system was used; this was followed by ventral placement of instrumentation and fusion. There were no surgery-related complications. Postoperative neurological status was unchanged in four patients and improved in six patients. No patient experienced neurological deterioration after undergoing this surgical approach. Conclusions. The authors conclude that a ventral surgical decompression, reduction, and stabilization procedure provides a safe and effective alternative for the treatment of patients with unilateral or bilateral cervical facet dislocation without significant bone disruption.

scholarly journals Treatment of chronic bilateral facet dislocation in a 6-year-old: A case report

2018 ◽  
Vol 6 ◽  
pp. 2050313X1881961
Author(s):  
Nabil Alassaf ◽  
Walid Attia
Keyword(s):  
Case Report ◽  
Motor Vehicle ◽  
Facet Dislocation ◽  
Vehicle Collision ◽  
Cord Injury ◽  
Spine Injuries ◽  
Paediatric Age ◽  
Skull Traction ◽  
Posterior Anterior ◽  
Anterior Posterior

Objectives: Spine injuries seldom affect the subaxial spine in children less than 9 years of age. We describe the management of a chronic paediatric bilateral facet dislocation. Methods: Case report and literature review. A 6-year-old boy presented 10 weeks after a motor vehicle collision with bilateral C4–C5 malunited facet dislocation. He had an incomplete spinal cord injury; right brown sequard hemiplegia, Frankel grade D. Results: Surgical management was through posterior–anterior–posterior approach without preoperative skull traction. Two years postoperatively, the child was asymptomatic, ambulating and functioning well. The injury had healed in radiographs. Conclusion: A combined approach for chronic bilateral facet dislocation applies to the paediatric age group to realign the spine.

Spinal stabilization by using crossed-screw anterior—posterior fixation after multisegmental total spondylectomy for thoracic chondrosarcoma

2001 ◽  
Vol 94 (2) ◽  
pp. 279-283 ◽  
Author(s):  
Jae-Won Doh ◽  
Andrea L. Halliday ◽  
Nevan G. Baldwin ◽  
Edward C. Benzel
Keyword(s):  
Malignant Tumors ◽  
Posterior Instrumentation ◽  
Posterior Fixation ◽  
Thoracic Vertebrae ◽  
Spinal Stability ◽  
High Grade ◽  
Content Type ◽  
Spinal Stabilization ◽  
Long Life ◽  
Anterior Posterior

✓ The authors describe the case of a 41-year-old man with high-grade chondrosarcoma who presented with a paraspinous mass extending into three thoracic vertebrae (T10–12). Crossfixed long anterior and posterior instrumentation was placed after three complete spondylectomies (T10–12). This technique augments spinal stability with an outrigger effect by using crossfixators placed between paired dorsal rods, as well as between the anterior and posterior hardware components. This technique may be used as an alternative when multiple vertebrae or all three spinal columns are involved by radioresistant malignant tumors in patients in whom there is a relatively long life expectancy.

A biomechanical comparison of three surgical approaches in bilateral subaxial cervical facet dislocation

2004 ◽  
Vol 1 (1) ◽  
pp. 108-115 ◽  
Author(s):  
Sung-Min Kim ◽  
T. Jesse Lim ◽  
Josemaria Paterno ◽  
Jon Park ◽  
Daniel H. Kim
Keyword(s):  
Statistical Significance ◽  
Axial Rotation ◽  
Anterior Cervical Discectomy ◽  
Content Type ◽  
Facet Dislocation ◽  
Loading Modes ◽  
Cervical Facet ◽  
Effective Stabilization ◽  
Flexion And Extension ◽  
Fine Print

Object. In bilateral cervical facet dislocation, biomechanical stabilities between anterior locking screw/plate fixation after anterior cervical discectomy and fusion (ACDFP) and posterior transpedicular screw/rod fixation after anterior cervical discectomy and fusion (ACDFTP) have not been compared using the human cadaver, although ACDFP has been performed frequently. In this study the stability of ACDFP, a posterior wiring procedure after ACDFP (ACDFPW), and ACDFTP for treatment of bilateral cervical facet dislocation were compared. Methods. Spines (C3—T1) from 10 human cadavers were tested in the intact state, and then after ACDFP, ACDFPW, and ACDFTP were performed. Intervertebral motion was measured using a video-based motion capture system. The range of motion (ROM) and neutral zone (NZ) were compared for each loading mode to a maximum of 2 Nm. The ROM for spines treated with ACDFP was below that of the intact spine in all loading modes, with statistical significance in flexion and extension, but NZs were decreased in flexion and extension and slightly increased in bending and axial rotation; none of these showed statistical significance. The ACDFPW produced statistically significant additional stability in axial rotation ROM and in flexion NZ than ACDFP. The ACDFTP provided better stability than ACDFP in bending and axial rotation, and better stability than ACDFPW in bending for both ROM and NZ. There was no significant difference in extension with either ROM or NZ for the three fixation methods. Conclusions. The spines treated with ACDFTP demonstrated the most effective stabilization, followed by those treated with ACDFPW, and then ACDFP. The spines receiving ACDFP also revealed a higher stability than the intact spine in most loading modes; thus ACDFP can also provide a relatively effective stabilization in bilateral cervical facet dislocation, but with the aid of a brace.

Chondroblastoma of the lumbar spine

2005 ◽  
Vol 2 (5) ◽  
pp. 596-600 ◽  
Author(s):  
Raphaël Vialle ◽  
Antoine Feydy ◽  
Ludovic Rillardon ◽  
Carla Tohme-Noun ◽  
Philippe Anract ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Local Recurrence ◽  
Osteolytic Lesion ◽  
Radicular Pain ◽  
Appendicular Skeleton ◽  
Lumbar Region ◽  
Content Type ◽  
Anterior Posterior ◽  
Fine Print

✓ Chondroblastoma is a benign cartilaginous neoplasm that generally affects the appendicular skeleton. Twenty-six cases of spinal chondroblastoma have been reported in the past 50 years, only six of which were located in the lumbar region. The authors report two cases involving this exceptional location. In both patients, low-back pain, in the absence of radicular pain, was the presenting symptom. In both cases, plain radiography and computerized tomography scanning revealed an osteolytic lesion surrounded by marginal sclerosis. Magnetic resonance imaging allowed the authors to study the tumor's local extension. Examination of a percutaneous fluoroscopy-guided biopsy sample revealed the following typical histological features of chondroblastoma: chondroid tissue, focally alternating with cellular areas, and no nuclear atypia or pleomorphism. To reduce the risk of local recurrence, vertebrectomy and anterior—posterior fusion were performed in both cases. In one case, a structural lumbar scoliosis was corrected during the posterior procedure. There was no postoperative complication. No recurrence was observed during the 3- to 6-year follow-up period. The surgery-related results were deemed successful. Although exceptional, the diagnosis of chondroblastoma is possible in lesions involving the lumbar spine. Other spinal locations are described in the literature, and frequency of recurrence is stressed. A vertebrectomy is advised to reduce the risk of local recurrence.

scholarly journals A standardized nomenclature for cervical spine soft-tissue release and osteotomy for deformity correction

2013 ◽  
Vol 19 (3) ◽  
pp. 269-278 ◽  
Author(s):  
Christopher P. Ames ◽  
Justin S. Smith ◽  
Justin K. Scheer ◽  
Christopher I. Shaffrey ◽  
Virginie Lafage ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Soft Tissue ◽  
Interrater Reliability ◽  
Soft Tissue Release ◽  
Spine Deformity ◽  
Intrarater Reliability ◽  
Perfect Agreement ◽  
Moderate Agreement ◽  
Posterior Anterior ◽  
Anterior Posterior

Object Cervical spine osteotomies are powerful techniques to correct rigid cervical spine deformity. Many variations exist, however, and there is no current standardized system with which to describe and classify cervical osteotomies. This complicates the ability to compare outcomes across procedures and studies. The authors' objective was to establish a universal nomenclature for cervical spine osteotomies to provide a common language among spine surgeons. Methods A proposed nomenclature with 7 anatomical grades of increasing extent of bone/soft tissue resection and destabilization was designed. The highest grade of resection is termed the major osteotomy, and an approach modifier is used to denote the surgical approach(es), including anterior (A), posterior (P), anterior-posterior (AP), posterior-anterior (PA), anterior-posterior-anterior (APA), and posterior-anterior-posterior (PAP). For cases in which multiple grades of osteotomies were performed, the highest grade is termed the major osteotomy, and lower-grade osteotomies are termed minor osteotomies. The nomenclature was evaluated by 11 reviewers through 25 different radiographic clinical cases. The review was performed twice, separated by a minimum 1-week interval. Reliability was assessed using Fleiss kappa coefficients. Results The average intrarater reliability was classified as “almost perfect agreement” for the major osteotomy (0.89 [range 0.60–1.00]) and approach modifier (0.99 [0.95–1.00]); it was classified as “moderate agreement” for the minor osteotomy (0.73 [range 0.41–1.00]). The average interrater reliability for the 2 readings was the following: major osteotomy, 0.87 (“almost perfect agreement”); approach modifier, 0.99 (“almost perfect agreement”); and minor osteotomy, 0.55 (“moderate agreement”). Analysis of only major osteotomy plus approach modifier yielded a classification that was “almost perfect” with an average intrarater reliability of 0.90 (0.63–1.00) and an interrater reliability of 0.88 and 0.86 for the two reviews. Conclusions The proposed cervical spine osteotomy nomenclature provides the surgeon with a simple, standard description of the various cervical osteotomies. The reliability analysis demonstrated that this system is consistent and directly applicable. Future work will evaluate the relationship between this system and health-related quality of life metrics.

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