Facet Dislocation Fractures of Subaxial Cervical Spine: A Treatment Algorithm for Surgical Approach Decision

Unilateral facet dislocation at the subaxial cervical spine (C3–7) in children younger than 8 years of age is rare. The authors describe a surgical approach for irreducible subaxial cervical unilateral facet dislocation (SCUFD) at C3–4 in a 5-year-old boy and present a literature review. A dorsal unilateral approach was applied, and a biodegradable plate was used for postreduction fixation without fusion after failed conservative treatment. There was complete resolution of symptoms and restored cervical stability. Two years after surgery, the patient had recovered range of motion in C3–4. In selected cases of cervical spine injury in young children, a biodegradable plate can maintain reduction until healing occurs, obviate the need to remove an implant, and recover the motion of the injured segment.

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Subaxial injury classification system to determine the surgical approach for subaxial cervical spine injuries

Current Orthopaedic Practice ◽

10.1097/bco.0b013e3282fa74b8 ◽

2008 ◽

Vol 19 (4) ◽

pp. 407-410

Author(s):

Marcel F Dvorak

Keyword(s):

Cervical Spine ◽

Surgical Approach ◽

Classification System ◽

Cervical Spine Injuries ◽

Subaxial Cervical Spine ◽

Spine Injuries ◽

Injury Classification

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Cervical facet dislocation: techniques for ventral reduction and stabilization

Journal of Neurosurgery Spine ◽

10.3171/spi.2000.92.1.0018 ◽

2000 ◽

Vol 92 (1) ◽

pp. 18-23 ◽

Cited By ~ 16

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.

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Anterior-Alone Surgical Treatment for Subaxial Cervical Spine Facet Dislocation: A Systematic Review

Global Spine Journal ◽

10.1177/2192568220907574 ◽

2020 ◽

pp. 219256822090757

Author(s):

Wendy Lee ◽

Chung Chek Wong

Keyword(s):

Systematic Review ◽

Cervical Spine ◽

Open Reduction ◽

Meta Analysis ◽

Fracture Dislocation ◽

Facet Dislocation ◽

Subaxial Cervical Spine ◽

Mesh Terms ◽

Facet Fracture ◽

Cervical Facet

Study Design: Systematic review. Objective: Anterior-alone surgery has gained wider reception for subaxial cervical spine facets dislocation. Questions remain on its efficacy and safety as a stand-alone entity within the contexts of concurrent facet fractures, unilateral versus bilateral dislocations, anterior open reduction, and old dislocation. Methods: A systematic review was performed with search strategy using translatable MESH terms across MEDLINE, EMBASE, VHL Regional Portal, and CENTRAL databases on patients with subaxial cervical dislocation intervened via anterior-alone approach. Two reviewers independently screened for eligible studies. PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) flow chart was adhered to. Nine retrospective studies were included. Narrative synthesis was performed to determine primary outcomes on spinal fusion and revisions and secondary outcomes on new occurrence or deterioration of neurology and infection rate. Results: Nonunion was not encountered across all contexts. A total of 0.86% of unilateral facet dislocation (1 out of 116) with inadequate reduction due to facet fragments between the facet joints removed its malpositioned plate following fusion. No new neurological deficit was observed. Cases that underwent anterior open reduction did not encounter failure that require subsequent posterior reduction surgery. One study (N = 52) on old dislocation incorporated partial corpectomy in their approach and limited anterior-alone approach to cases with persistent instability. Conclusions: This systematic review supports the efficacy and success of anterior reduction, fusion, and instrumentation for cervical facet fracture dislocation. It is safe from a neurological standpoint. Revision rate due to concurrent facet fracture is low. Certain patients may require posteriorly based surgery or in specific cases combined anterior and posterior procedures.

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Retrospectıve Evaluatıon of Our Surgıcal Approach and Treatment Results in Subaxıal Cervıcal Spıne Injury

Kocaeli Medical Journal ◽

10.5505/ktd.2021.43403 ◽

2021 ◽

Vol 10 (2) ◽

pp. 33-38

Author(s):

Durmuş Oğuz Karakoyun ◽

Oğuzhan Uzlu ◽

Ali Yılmaz ◽

Hasan Serdar Işık

Keyword(s):

Cervical Spine ◽

Surgical Approach ◽

Cervical Spine Injury ◽

Spine Injury ◽

Retrospective Evaluation ◽

Treatment Results ◽

Subaxial Cervical Spine

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The Surgical Approach to Subaxial Cervical Spine Injuries

Spine ◽

10.1097/brs.0b013e318158ce16 ◽

2007 ◽

Vol 32 (23) ◽

pp. 2620-2629 ◽

Cited By ~ 123

Author(s):

Marcel F. Dvorak ◽

Charles G. Fisher ◽

Michael G. Fehlings ◽

Y Raja Rampersaud ◽

F C. Öner ◽

...

Keyword(s):

Cervical Spine ◽

Surgical Approach ◽

Cervical Spine Injuries ◽

Subaxial Cervical Spine ◽

Spine Injuries

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Growth and alignment of the pediatric subaxial cervical spine following rigid instrumentation and fusion: a multicenter study of the Pediatric Craniocervical Society

Journal of Neurosurgery Pediatrics ◽

10.3171/2018.1.peds17551 ◽

2018 ◽

Vol 22 (1) ◽

pp. 81-88 ◽

Cited By ~ 4

Author(s):

Hannah E. Goldstein ◽

Justin A. Neira ◽

Matei Banu ◽

Philipp R. Aldana ◽

Bruno P. Braga ◽

...

Keyword(s):

Cervical Spine ◽

Multicenter Study ◽

Surgical Approach ◽

Adjacent Segment ◽

Long Term Effects ◽

Vertical Growth ◽

Subaxial Cervical Spine ◽

Surgical Fusion

OBJECTIVEThe long-term effects of surgical fusion on the growing subaxial cervical spine are largely unknown. Recent cross-sectional studies have demonstrated that there is continued growth of the cervical spine through the teenage years. The purpose of this multicenter study was to determine the effects of rigid instrumentation and fusion on the growing subaxial cervical spine by investigating vertical growth, cervical alignment, cervical curvature, and adjacent-segment instability over time.METHODSA total of 15 centers participated in this multi-institutional retrospective study. Cases involving children less than 16 years of age who underwent rigid instrumentation and fusion of the subaxial cervical spine (C-2 and T-1 inclusive) with at least 1 year of clinical and radiographic follow-up were investigated. Charts were reviewed for clinical data. Postoperative and most recent radiographs, CT, and MR images were used to measure vertical growth and assess alignment and stability.RESULTSEighty-one patients were included in the study, with a mean follow-up of 33 months. Ninety-five percent of patients had complete clinical resolution or significant improvement in symptoms. Postoperative cervical kyphosis was seen in only 4 patients (5%), and none developed a swan-neck deformity, unintended adjacent-level fusion, or instability. Of patients with at least 2 years of follow-up, 62% demonstrated growth across the fusion construct. On average, vertical growth was 79% (4-level constructs), 83% (3-level constructs), or 100% (2-level constructs) of expected growth. When comparing the group with continued vertical growth to the one without growth, there were no statistically significant differences in terms of age, sex, underlying etiology, surgical approach, or number of levels fused.CONCLUSIONSContinued vertical growth of the subaxial spine occurs in nearly two-thirds of children after rigid instrumentation and fusion of the subaxial spine. Failure of continued vertical growth is not associated with the patient’s age, sex, underlying etiology, number of levels fused, or surgical approach. Further studies are needed to understand this dichotomy and determine the long-term biomechanical effects of surgery on the growing pediatric cervical spine.

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Contiguous-Level Unilateral Cervical Spine Facet Dislocation—A Report of a Less Discussed Subtype

Journal of Neurosciences in Rural Practice ◽

10.1055/s-0041-1742135 ◽

2022 ◽

Author(s):

Sunil Kumar Das ◽

Arunkumar Sekar ◽

Srinivas Jaidev ◽

Ashis Patnaik ◽

Rabi Narayan Sahu

Keyword(s):

Cervical Spine ◽

High Velocity ◽

English Language ◽

Spinal Column ◽

Axial Rotation ◽

Contralateral Side ◽

Neurological Injury ◽

Multiple Level ◽

Facet Dislocation ◽

Subaxial Cervical Spine

AbstractUnilateral facet dislocation of subaxial cervical spine trauma is characterized by dislocation of inferior facet of superior vertebra over the superior facet of inferior vertebra. The injury is due to high-velocity trauma and associated with instability of spinal column. Such unilateral facet dislocations occurring at multiple adjacent levels for some reason are not reported or studied frequently. We have reported two cases of multiple-level dislocation of unilateral facets managed in our hospital with a review of available literature. The injury occurs as one side of the motion segment translates and rotates around an intact facet on the contralateral side. The major mechanism of injury is distractive flexion injury with axial rotation component. The injury is associated with instability secondary to loss of the discoligamentous complex. In cases with multiple-level dislocations of unilateral cervical facets, there are multiple mechanisms associated with significant neurological injury and most of them succumb at the site of injury. Only three other cases are available in English language literature. The neurological outcome is invariably poor. Multiple-level facet dislocations of subaxial cervical spine are reported sparsely in literature. We suspect that due to high-velocity nature of these injuries, most of them succumb soon after injury and not often reported. This article reports two cases of contiguous-level unilateral facet dislocation of subaxial cervical spine with associated injuries and the outcomes with review of literature.

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