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

Objective: To perform an analysis of the surgical approach choice in subaxial cervical spine (SCS) facet dislocations. Method: The inclusion criteria were as follows: radiologically confirmed traumatic SCS facet dislocation, 18-70 years of age, stable medical condition, and isolated cervical trauma. The management scheme was based on the presence of traumatic disc herniation (TDH) and the grade of dislocation according to the Allen and Ferguson classification (AFC). In the absence of TDH, the reduction was attempted via traction under general anesthesia before surgery. In the presence of TDH, the reduction was attempted after anterior discectomy. Posterior open reduction was performed in case of an unsuccessful reduction attempt. Anterior stabilization was sufficient in AFC distractive flexion stage (DFS) 2 fractures while combined stabilization was performed in DFS 3 and 4 fractures. Results: Thirty-two patients were included in the study. TDH was detected in 14 patients. The number of patients with DFS 2, 3, and 4 fractures was 6, 18, and 8, respectively. Posterior open reduction was needed in 9 patients. Anterior stabilization was performed in 6 patients (3 with TDH, 3 without TDH) and combined stabilization was performed in 26 patients (11 with TDH, 15 without TDH) via 6 anterior, 7 anterior-posterior, 15 posterior-anterior, and 4 anterior-posterior-anterior approaches. Satisfactory follow-up results were achieved in radiological and neurological evaluations, and neck pain scores. Conclusion: The treatment algorithm for subaxial facet dislocations based on DFS and TDH presence provided satisfactory results.Keywords: Allen and Ferguson classification, decision-making, facet dislocation fracture, subaxial cervical spine, subaxial injury classification and Severity scale, traumatic disc herniation

Subaksiyel Servikal Omurganın Faset Dislokasyon Fraktürleri: Cerrahi Yaklaşım Kararı için Tedavi Algoritması

Amaç: Bu çalışmada subaksiyel servikal omurga (SSO) faset dislokasyon fraktürlerinde cerrahi yaklaşım seçimi algoritması geliştirilmesi amaçlanmıştır. Yöntem: Çalışmaya dahil edilme kriterleri şu şekildeydi: Radyolojik olarak gösterilmiş travmatik SSO faset dislokasyon fraktürü, 18-70 yaş, medikal olarak stabil durum ve izole servikal travma varlığı. Tedavi algoritması temel olarak, travmatik disk herniasyonu (TDH) varlığına ve Allen ve Ferguson sınıflamasına (AFS) göre dislokasyon derecesine göre düzenlenmekteydi. Radyolojik incelemelerde TDH saptanmazsa, cerrahi girişim öncesinde genel anestezi altında traksiyon ile redüksiyon denenmesi yapılmaktaydı. TDH varlığında ise traksiyon denemesi öncesinde anterior diskektomi yapılmaktaydı. Eğer traksiyon ile redüksiyon girişimi başarısız olursa, posterior açık redüksiyon yapılmaktaydı. AFS’sine göre distraktive fleksiyon evre (DFE) 2 fraktürlerinde anterior stabilizasyon uygulanırken, DFE 3 ve 4 dislokasyonlarda kombine stabilizasyon yapılmaktaydı. Bulgular: Çalışmaya 32 hasta dahil edildi. On dört hastada radyolojik incelemelerde TDH saptandı. Altı hastada DFE 2, 18 hastada DFE 3 ve 8 hastada DFE 4 faset dislokasyon fraktürü mevcut idi. Posterior açık redüksiyon 9 hastada gerekli oldu. Altı hastaya (3 TDH’si olan, 3 TDH’si olmayan) anterior stabilizasyon ve 26 hastaya (11 TDH’si olan, 15 TDH’si olmayan) kombine stabilizasyon uygulandı. Altı anterior, 7 anterior-posterior, 15 posterior-anterior ve 4 anterior-posterior-anterior yaklaşım uygulandı. Radyolojik, nörolojik değerlendirmelerde ve boyun ağrısı skorlarında tatmin edici sonuçlar elde edildi. Sonuç: DFE ve TDH varlığına göre oluşturulan subaksiyel faset dislokasyonları için cerrahi tedavi algoritması ile başarılı sonuçlar elde edilmiştir.

Kaynakça

1. Oh SH, Perin NI, Cooper PR. Quantitative three-dimensional anatomy of the subaxial cervical spine: Implication for anterior spinal surgery. Neurosurgery 1996;38(6):1139-1144.

2. Lopez AJ, Scheer JK, Leibl KE, Smith ZA, Dlouhy BJ, Dahdaleh NS. Anatomy and biomechanics of the craniovertebral junction. Neurosurg Focus 2015;38(4):E2.

3. Leucht P, Fischer K, Muhr G, Mueller EJ. Epidemiology of traumatic spine fractures. Injury 2009;40(2):166-172.

4. Pickett GE, Campos-benitez M, Keller JL, Duggal N. epidemiology of traumatic spinal cord injury in canada epidemiology of traumatic spinal cord injury in canada. Spine (Phila Pa 1976) 2015;31(7):799-805.

5. Wang H, Zhang Y, Xiang Q, Wang X, Li C, Xiong H, et al. Epidemiology of traumatic spinal fractures: Experience from medical universityaffiliated hospitals in Chongqing,China, 2001-2010: Clinical article. J Neurosurg Spine 2012;17(5):459-468.

6. Ryan MD, Henderson JJ. The epidemiology of fractures and fracture-dislocations of the cervical spine. Injury 1992;23(1):38-40.

7. Allen BL, Ferguson RL, Lehmann TR, O’Brien RP. A mechanistic classification of closed, indirect fractures and dislocations of the lower cervical spine. Spine (Phila Pa 1976) 1982;7(1):1-27.

8. Jiang X, Yao Y, Yu M, Cao Y, Yang H. Surgical treatment for subaxial cervical facet dislocations with incomplete or without neurological deficit : a prospective study of 52 cases. Med Sci Monit 2017;23:732-740.

9. Wang B, Zhu Y, Jiao Y, Wang F, Liu X, Zhu H, et al. A new anteriorposterior surgical approach for the treatment of cervical facet dislocations. J Spinal Disord Tech 2014;27(3):E104-109.

10. Du W, Wang C, Tan J, Shen B, Ni S, Zheng Y. Management of subaxial cervical facet dislocation through anterior approach monitored by spinal cord evoked potential. Spine (Phila Pa 1976) 2014;39(1):48-52.

11. Hadley MN, Walters BC, Grabb PA, Oyesiku NM, Przybylski GJ, Resnick DK, et al. Treatment of subaxial cervical spinal injuries. Neurosurgery 2002;50(3 Suppl):S156-165.

12. Lins CC, Prado DT, Joaquim AF. Surgical treatment of traumatic cervical facet dislocation: anterior, posterior or combined approaches? Arq Neuropsiquiatr 2016;74(9):745-749.

13. Liu K, Zhang Z. A novel anterior-only surgical approach for reduction and fixation of cervical facet dislocation. World Neurosurg 2019;128:e362-e369.

14. Vital JM, Gille O, Sénégas J, Pointillart V. Reduction technique for uni- and biarticular dislocations of the lower cervical spine. Spine (Phila Pa 1976) 1998;23:949-954.

15. Gelb DE, Hadley MN, Aarabi B, Dhall SS, Hurlbert RJ, Rozzelle CJ, et al. Initial closed reduction of cervical spinal fracture-dislocation injuries. Neurosurgery 2013;72(Suppl 2):73-83.

16. Rizzolo SJ, Piazza MR, Cotler JM, Balderston RA, Schaefer D, Flanders A. Intervertebral disc injury complicating cervical spine trauma. Spine (Phila Pa 1976) 1991;16(6 Suppl):S187-189.

17. Nakashima H, Yukawa Y, Ito K, Machino M, El Zahlawy H, Kato F. Posterior approach for cervical fracture-dislocations with traumatic disc herniation. Eur Spine J 2011;20(3):387-394.

18. Vaccaro AR, Hulbert RJ, Patel AA, Fisher C, Dvorak M, Lehman RA, et al. The subaxial cervical spine injury classification system: A novel approach to recognize the importance of morphology, neurology, and integrity of the disco-ligamentous complex. Spine (Phila Pa 1976) 2007;32(21):2365-2374.

19. Nassr A, Lee JY, Dvorak MF, Harrop JS, Dailey AT, Shaffrey CI, et al. Variations in surgical treatment of cervical facet dislocations. Spine (Phila Pa 1976) 2008;33(7):E188-193.

20. Yisheng W, Fuying Z, Limin W, Junwei L, Guofu P, Weidong W. First aid and treatment for cervical spinal cord injury with fracture and dislocation. Indian J Orthop 2007;41(4):300-304.

21. Reindl R, Ouellet J, Harvey EJ, Berry G, Arlet V. Anterior reduction for cervical spine dislocation. Spine (Phila Pa 1976) 2006;31(6):648-652.

22. Park JH, Roh SW, Rhim SC. A single-stage posterior approach with open reduction and pedicle screw fixation in subaxial cervical facet dislocations. J Neurosurg Spine 2015;23(1):35-41.

23. Feng G, Hong Y, Li L, Liu H, Pei F, Song Y, et al. Anterior decompression and nonstructural bone grafting and posterior fixation for cervical facet dislocation with traumatic disc herniation. Spine (Phila Pa 1976) 2012;37(25):2082-2088.

Kaynak Göster

134 127

Arşiv
Sayıdaki Diğer Makaleler

Retrospective Evaluation of the Clinical Findings and Bone Mineral Densitometry Results of Children with Celiac Disease

Sezin NAİBOĞLU, Zerrin ÖNAL

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

Barış ÖZÖNER, Levent AYDIN, Songül Meltem CAN, Ahmet Murat MÜSLÜMAN, Adem YILMAZ

Assessment of the Quality and Reliability of the Information on Bone Tumor on Youtube

Sezgin Bahadır TEKİN, Erman ÖĞÜMSÖĞÜTLÜ

Predictive Role of Monocyte to High-density Lipoprotein Ratio for Plaque Morphology in Asymptomatic Intermediate Carotid Stenosis

Erdem KARAÇÖP, Asım ENHOŞ

Evaluation of Childhood Posterior Fossa Malignant Tumors: A Single-center Study

Burak EREN, İlker GÜLEÇ, Nuri Serdar BAŞ

Effect of Static and Dynamic Stretching on Knee Muscle Strength in Trained Players

Chasan Mola ALİ, Filiz TUNA, Hasan Kerem ALPTEKİN, Derya DEMİRBAĞ KABAYEL, Hakan TUNA

Interleukin-6 Levels in the Cervicovaginal Fluid of Pregnant Women and Its Predictive Value in Preterm Delivery

Pelin ERGENEKON

Correlation of Early Subarachnoid Hemorrhage on Serum Endothelin and von Willebrand Factor with Clinical and Radiological Parameters

Serkan KİTİS, Meliha GÜNDAĞ PAPAKER, ERAY METİN GÜLER

Association of Cervical Screening Results with Colposcopic Findings

Derya KILIÇ, Tolga GÜLER

The Importance of De Ritis Ratio in Patients with Bladder Cancer

Kasım ERTAŞ, Recep ERYILMAZ, Rahmi ASLAN, Murat DEMİR, Kerem TAKEN