Autostabilization of neglected high-grade fracture–dislocation in the cervical spine

Shah, Kunal; Gadiya, Akshay; Nene, Abhay

doi:10.4103/jcvjs.jcvjs_92_18

Cited by 3 publications

(3 citation statements)

References 5 publications

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“…17 Shah et al reported two cases with delayed presentation of cervical facet dislocation and observed autostabilization without any progression of deformity. 21 Bodman and Chin and Sulla and Mach made similar observations. 22,23 They concluded that once healed, these injuries are stable without surgical intervention.…”

Section: Discussionmentioning

confidence: 63%

Neglected Cervical Facet Dislocation without Neurological Deficit: A Simple Solution to a Complex Problem—A Case Series and Review

Kumar,

Rai,

Dhatt

2024

Indian Journal of Neurotrauma

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Cervical facet dislocation is a disastrous injury. Delayed presentation is not uncommon owing to various reasons in developing countries. Autofusion and a halt in progression are seen in spondylolysis and spondylolisthesis. Conservative treatment with close observation can be offered to the carefully selected patients with neglected cervical facet dislocations with intact neurology, as the injury is stable after autofusion. We registered eight male patients with cervical facet dislocation with delayed presentation for various reasons. Dynamic radiographs, computed tomography (CT) scan, and magnetic resonance imaging (MRI) were done to rule out any instability, cord compression, or bony fusion. Patients were followed up for 6 months clinically and radiologically. A total of eight patients presented with cervical facet dislocation, with a mean delay in presentation of 33 weeks (range: 14–54 weeks). Postinjury, all the patients were neurologically intact, with the only complaint of cervical pain at presentation. Dynamic radiographs did not show any instability. No cord compression or changes were noted on the MRI. Conservative management was advised for all eight patients. A subsequent follow-up CT scan demonstrated bony fusion at the dislocated facets in three of these patients. All the patients remained neurologically intact, with no further progression of the deformity. Surgical management is the mainstay of treatment for neglected facet dislocations. A combined approach has been advocated in most of the studies for proper reduction and alignment in these cases, which is quite extensive and has its own morbidity. A trial of conservative treatment can be offered to selected patients with intact neurology.

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Section: Discussionmentioning

confidence: 63%

Neglected Cervical Facet Dislocation without Neurological Deficit: A Simple Solution to a Complex Problem—A Case Series and Review

Kumar,

Rai,

Dhatt

2024

Indian Journal of Neurotrauma

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“…Complications and events to anticipate include bleeding, prolonged hospital stay, need for ICU admission, wound complications, pseudoarthrosis, and fixation failure (Table 3). When surgical risks outweigh the benefits, conservative treatment is preferred [11,34].…”

Section: Treatment Goals and Expectationsmentioning

confidence: 99%

“…Thompson and Hohl [11] treated conservatively an asymptomatic alcoholic patient with bilateral cervical facet dislocation who presented years after the index trauma. Shah et al [34] reported 2 cases of neglected cervical facet dislocations that were managed conservatively. For all these cases, there was radiological fusion with moderate deformity, and without neurological deficit (Figure 5).…”

Section: Conservative Treatment Partial Reduction and In Situ Fusionmentioning

confidence: 99%

Delayed presentation of lower cervical facet dislocations: What to learn from past reports?

Nkurikiyumukiza,

Buteera,

El-Sharkawi

2024

SICOT-J

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Delayed presentation of lower cervical facet dislocations is uncommon, and there is no standardized way to approach these neglected injuries. The literature on neglected lower cervical facet dislocations is limited to case reports and few retrospective studies. This justifies the need for a comprehensive review of this condition. Our purpose was to elaborate a review on the epidemiology, clinical and radiological presentation, and treatment techniques and approach to these neglected injuries. Middle-aged adults from 30 to 50 represent 73.8% of reported cases, and most of them are males (72.0%). The most affected level is C5–C6 (43.0%). While most delays are due to missed injuries (52.1%) and ineffective non-operative treatment (36.2%), the other reason for delay is negligence in seeking medical care (11.7%). Patients present with variable degrees of neurological deficit, persistent neck pain, and neck stiffness. Reported approaches and techniques to reduce and stabilize these injuries are highly variable and depend on the surgeon’s judgment, experience, and preference. Fibrotic tissues and bony fusion around the dislocated facet joint contribute to the reduction challenge, and 77.0% of closed reduction attempts fail. Anterior and posterior approaches to the cervical spine are used selectively or in combination for surgical release, reduction, and stabilization. Despite the lack of standardized treatment guidelines and different approaches, most of the authors reported improvement in pain, balance, and neurology post-surgery. Starting with the posterior surgical approach aims to achieve reduction compared to the anterior approach which largely aims at spinal decompression. Given the existing controversies, the need for quality prospective studies to determine the best treatment approach for lower cervical facet dislocations presenting with delay is evident.

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Neglected bilateral facet dislocation of the cervical spine with intact neurology: Reduction technique

2020

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Bilateral cervical facet dislocation is a serious injury that in majority cause neurologic deficit requiring prompt medical attention. Rarely, they retain normal neurology due to spontaneous decompression even though patients can have objective myelopathic or root compression signs. Neglected cases with normal neurology are uncommon with only few of them reported in the literature but their management is still a matter of debate. Here, we report a case of a 26-year-old female who had neglected bilateral facet dislocation with neck stiffness that was operated with posteroanterior approach with near-complete reduction and intact neurology. We describe the technique employed and discuss the literature.

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Autostabilization of neglected high-grade fracture–dislocation in the cervical spine

Cited by 3 publications

References 5 publications

Neglected Cervical Facet Dislocation without Neurological Deficit: A Simple Solution to a Complex Problem—A Case Series and Review

Neglected Cervical Facet Dislocation without Neurological Deficit: A Simple Solution to a Complex Problem—A Case Series and Review

Delayed presentation of lower cervical facet dislocations: What to learn from past reports?

Neglected bilateral facet dislocation of the cervical spine with intact neurology: Reduction technique

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