Management of Neglected Post-traumatic Bilateral Facet Dislocation of Sub-axial Cervical Spine: A Case Series

Abstract

Neglected bilateral facet dislocation of the lower cervical spine is a rare condition and found mostlyin developing countries like Nepal. Delayed presentation makes treatment more challengingconcerning decompression, reduction, neurological recovery, and overall outcome. We managedthree cases of bilateral facet dislocations of the fifth-sixth-seventh cervical vertebra level presentedafter three months of injury. All of those were treated surgically by combined anterior-posterioranterior approaches with the same principle. One patient had a complete neurological recovery, thesecond one recovered partially with few long-term complications and the third one did not improveat all.

Risk factors and surgical approaches in neglected subaxial cervical spine fractures‐dislocations: Experiences with two cases and literature review

“…Marasini reported three patients who were treated with an APA approach after failed attempts of closed reduction: anterior decompression, posterior reduction by partial facetectomy, stabilization, and fusion by using lateral mass screws and bone graft, anterior cervical fusion by using a mesh cage, cancellous bone graft, and anterior cervical plating was performed. Two patients improved however, there was no neurological improvement in one patient at a follow‐up of 6 months 2 …”

“…Two patients improved however, there was no neurological improvement in one patient at a follow-up of 6 months. 2 Liu et al 32 provided supportive evidence for PA approach in nine patients with a mean age of 45 years. The sequence of surgery consisted of two stages: posterior procedure (soft tissue release, facetectomy, and interspinous wiring) followed by anterior stage (soft tissue release, discectomy, reduction, intervertebral grafting, and anterior plating).…”

“…These injuries often lead to neurological deficits, chronic pain, and cervical deformity 5,6 . There is no clear approach for treatment of neglected subaxial fracture‐dislocation in guidelines, 7,8 but a few literatures have suggested algorithms to obtain maximum alignment and resolve neurological symptoms 2,7,9,10 . Several surgical strategies such as single anterior, 6 single posterior, 11 posterior–anterior, 12–15 posterior–anterior–posterior, 7,16 and anterior–posterior–anterior–posterior 7 approaches have been reported but more studies are needed to conclude a definite protocol.…”

“…2 Moreover, living in the rural areas, inaccessibility of nearby specialized medical centers, unconsciousness and multiple traumatized patients account for the other risk factors predisposing to negligence of the spine. 2,3 If the closed reduction in another patient successfully. Except one of our cases who died after 2 weeks of surgery due to aspiration pneumonia, other one found complete improvement at the end of 6-month follow-up.…”

“…5,6 There is no clear approach for treatment of neglected subaxial fracture-dislocation in guidelines, 7,8 but a few literatures have suggested algorithms to obtain maximum alignment and resolve neurological symptoms. 2,7,9,10 Several surgical strategies such as single anterior, 6 single posterior, 11 posterior-anterior, [12][13][14][15] posterior-anteriorposterior, 7,16 and anterior-posterior-anterior-posterior 7 approaches have been reported but more studies are needed to conclude a definite protocol. We report our experience of surgical strategies of two patients with neglected subaxial cervical spine fracture-dislocation that came to our center with subsequent follow-ups.…”