A Levering Technique for Open Reduction of Traumatic Unilateral Locked Facets of Cervical Spine: Technical Note

Abstract

Reduction of traumatic unilateral locked facets of the cervical spine can be accomplished by closed or open means. If closed reduction is unsuccessful, then open reduction is indicated. The previously described techniques of open reduction of a unilateral locked facets of the cervical spine in the literature included drilling facet, forceful manipulation or using special equipment. We describe a reduction technique that uses a basic spinal curette, in a forceless manner, and it does not need facet drilling. We have successfully used this technique in 5 consecutive patients with unilateral locked facets. There have been no complications related to this technique.

Subaxial Cervical Spine Injuries: WFNS Spine Committee Recommendations

“…In the posterior approach, a direct reduction of a locked facet can be achieved by drilling out the upper half of jumped facet and yanking the lower fact with a curette. 55…”

Reduction of Lower Cervical Facet Dislocation: A Review of All Techniques

“…In some instances, if the adhesions could not be broken up, the ventral margin of the involved superior facet, or even the whole facet, might have to be removed to complete the reduction. Subsequently, using the same principle of leverage, Bunyaratavej et al 79 in 2011 and Park et al 80 in 2015 respectively reported a similar mean assisted by the spinal curette. A small straight spinal curette was placed between the inferior facet of the rostral vertebra and the superior facet of the caudal vertebra.…”

A Levering Technique Using Small Parallel Rods for Open Reduction of High-Grade Thoracolumbar Dislocation

“…Vertebral dislocations are high-energy lesions, which have especially been described at the highly mobile, high-stress junctional segments of the vertebral column, including the cervical vertebrae, thoracolumbar junctions, and lumbosacral junctions. 1 , 2 , 13 , 14 Literature has also described a few cases of mid-lumbar vertebral dislocations, involving unilateral and bilateral displacements of the facetal articulations. 5 These injuries have usually ensued high-velocity road traffic accidents or falls from heights, although certain underlying conditions, such as spinal bifida or rheumatoid arthritis may facilitate these injuries, even in situations of less violent trauma.…”

“…Nevertheless, this practice of closed pre-operative traction is fraught with possible complications resulting from overstretching of lumbar roots or brachial plexus; or as a consequence of immobilization (eg, deep vein thrombosis). 5 Diverse open reduction maneuvers have been broadly discussed, including direct manual reduction by applying traction to the spinous processes, 5 applying distraction using interspinous laminar spreaders, 26 – 29 or using small curettes 13 to maneuver the superior jumped facet out of the locked position (especially in the subaxial cervical spine). Notwithstanding, these manipulations have a significant rate of failure in achieving reduction, which may necessitate more invasive procedures, such as partial facetectomies and laminectomies and resection of ligamentum flavum or other soft-tissue or bony remnants (which may hinder the reduction).…”

“… 8 – 10 The reduction procedures and techniques, which may be adopted in these situations, have been multifariously discussed so far in the literature. 1 – 14 The current article discusses a novel reduction maneuver, which we have employed in these circumstances and achieved precise sagittal balance as well as vertebral alignment with minimal soft tissue damage. The technical intricacies, benefits and pitfalls of this maneuver, detailed stepwise procedure involved and a brief literature review on alternative maneuvers employed hitherto, have been discussed elaborately.…”