Background: Facet dislocation constituted an important subgroup of cervical spine
injuries that result from flexion-rotation or flexion-distraction injury. Management of
cervical spine dislocations represents an area of substantial controversy regarding the
appropriate diagnostic work-up and the available treatment options either conservative
or surgical. Anterior cervical approach is an option for treatment of cervical spine facet
dislocations. Objectives: To evaluate the efficacy and safety of anterior cervical
stabilization in treatment of cervical facet dislocation and to review the specific areas of
controversy generated by this issue. Patients and Methods: Ten patients with single
level cervical facet dislocation were admitted in the Department of Neurosurgery, Benha
University in the period between January 2012 and December 2014. Seven male and
three female patients who ranged in age from 18 to 50 years (average 32.1 years). Six
patients presented with unilateral cervical facet dislocation and four patients with
bilateral cervical facet dislocation. The level of facet dislocation was C5–6 in four, C6–7
in two, C3-4 in two and C4–5 in two patients. Three patients presented with a complete
spinal cord injury (SCI), two patients with an incomplete SCI, four with radicular
symptoms, and one patient was neurologically intact. All patients underwent
computerized tomography evaluation of the cervical spine. Plain radiography and
preoperative MRI cervical spine were not routinely done, but tailored according to
patient's condition. Decompression, reduction, and stabilization of the cervical spine
via the ventral approach were accomplished in all cases. Results: Adequate
decompression of neural tissue by satisfactory reduction of deformity and meticulous
diskectomy was achieved in all patients, followed by fixation using anterior plate.
Postoperative neurological status was unchanged in three patients and improved in four
patients, one patient died due to respiratory compromise caused by diaphragmatic
paralysis that was present preoperatively. There was no deterioration of preoperative
neurological function. The only complication related to the approach was transient
recurrent laryngeal nerve palsy encounterd in one case. Conclusion: Anterior cervical
approach is effective and reliable alternative for decompression, reduction, and
stabilization of the dislocated cervical spine facets in selected patients.
© 2015 Egyptian Journal of Neurosurgery. Published by MEDC. All rights reserved |
