Reduction of traumatic dislocations and facet fracture-dislocations in the lower cervical spine

Reinhold, M.; Knop, C.; Lange, U.; Rosenberger, Ralf; Schmid, RM; Blauth, M.

doi:10.1007/s00113-006-1188-0

Cited by 16 publications

(10 citation statements)

References 50 publications

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“…The majority of dislocations are amenable for closed reduction [77,78,89] or reduction can be achieved intraoperatively [29,77] as it was in the current study. ACDFP became popular as satisfactory clinical outcomes, low complication but high fusion rates were reported [3,11,56,64,77].…”

Section: Reconstruction and Maintenance Of Sagittal Alignmentmentioning

confidence: 99%

Mid- to long-term outcome of instrumented anterior cervical fusion for subaxial injuries

et al. 2009

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The management of patients with subaxial cervical injuries lacks consensus, particularly in regard to the decision which surgical approach or combination of approaches to use and which approach yields the best clinical outcome in the distinct injury. The trauma literature is replete with reports of surgical techniques, complications and gross outcome assessment in heterogeneous samples. However, data on functional and clinical outcome using validated outcome measures are scanty. Therefore, the authors performed a study on plated anterior cervical decompression and fusion for unstable subaxial injuries with focus on clinical outcome. For the purpose of a strongly homogenous subgroup of patients with subaxial injuries without spinal cord injuries, robust criteria were applied that were fulfilled by 28 patients out of an original series of 131 subaxial injuries. Twenty-six patients subjected to 1-and 2-level fusions without having spinal cord injury could be surveyed after a mean of 5.5 years (range 16-128 months). The cervical spine injury severity score averaged 9.6. Cross-sectional outcome assessment included validated outcome measures (Neck pain disability index, Cervical Spine Outcome Questionnaire, SF-36), the investigation of construct failure and successful surgical outcome were defined by strict criteria, the reconstruction and maintenance of local and total cervical lordosis, adjacent-segment degeneration and intervertebral motion, and the fusion-rate using an interobserver assessment. Selfrated clinical outcome was excellent or good in 81% of patients and moderate or poor in 19% that corresponded to the results of the validated outcome measures. Results of the NPDI averaged 12.4 ± 12.7% (0-40). With the SF-36 mean physical and mental component summary scores were 47.0 ± 9.8 (18.2-59.3) and 52.2 ± 12.4 (14.6-75.3), respectively. Using merely non-constrained plates, construct failure was observed in 31% of cases and loss of local lordosis, expressed as a mean injury angle of 14°, postoperative angle of -5.5°and follow-up angle of -1°, was significant. However, total cervical lordosis was within the limits of normalcy (-24.3°± 13.3) and fusion-rate was 88.5%. The progression of adjacent-level degeneration was shown to be significantly influenced by a decreased plate-to-disc-distance. Adjacent-level intervertebral motion was not altered due to the adjacent fusion, but reduced in Electronic supplementary material The online version of this article

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Section: Reconstruction and Maintenance Of Sagittal Alignmentmentioning

confidence: 99%

Mid- to long-term outcome of instrumented anterior cervical fusion for subaxial injuries

et al. 2009

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“…Diese ist entweder manuell ohne Hilfsmittel oder Mithilfe einer Schädelklemme (Crutchfield, Mayfield, Haloring) möglich [4]. Sie kann direkt präoperativ oder als Dauertraktionsbehandlung über mehrere Tage stattfinden.…”

Section: Geschlossene Repositionunclassified

Luxationsfrakturen der unteren HWS – dorsal beginnen!

Stoffel

2018

Die Wirbelsäule

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Luxationsfrakturen der unteren HWS – also ab Hw3 abwärts – sind komplexe und meist hoch instabile Verletzungen, die einer operativen Therapie bedürfen. In diesem Pro/Kontra-Beitrag werden diese Verletzungen zunächst in die Systematik der AO-Spine Klassifikation eingeordnet, die adäquate Diagnostik erläutert und die Behandlungsziele definiert. Nach Vorstellung der grundsätzlichen Therapieoptionen werden die Bedingungen dargelegt, die für ein primär dorsales Vorgehen sprechen: (1) eine dorsal des Myelons gelegene traumatische Raumforderung oder die Notwendigkeit zur mehrsegmentalen Dekompression, (2) eine traumatische Foramenstenose, (3) eine ankylosierende Grunderkrankung oder (4) eine verminderte Knochendichte.

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“…Zur geschlossenen Reposition stehen unterschiedliche Methoden zur Verfügung [13]. Es besteht ein zeitlicher Zusammenhang zwischen Erfolg und Misserfolg eines erfolgreichen geschlossenen Repositionsmanövers bei Facettengelenkluxation (bzw.…”

Section: C-verletzungenunclassified

“…-frakturen) der subaxialen HWS. Deshalb sollte dieser möglichst zeitnah und durch einen hierin geübten Behandler unter Bildwandlerdurchleuchtung in OP-Bereitschaft oder direkt im OP durchgeführt werden [13]. Eine Relaxierung des Patienten ist zu empfehlen.…”

Section: C-verletzungenunclassified

Therapieempfehlungen zur Versorgung von Verletzungen der subaxialen Halswirbelsäule

et al. 2017

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In a consensus process during four sessions in 2016, the working group "lower cervical spine" of the German Society for Orthopedic and Trauma Surgery (DGOU), formulated "Therapeutic Recommendations for the Lower Cervical Spine", taking into consideration the current literature. Therapeutic goals are a permanently stable, painless cervical spine and the protection against secondary neurologic damage while retaining the greatest possible amount of motion and spinal profile. Due to its ease of use and its proven good reliability, the AOSpine classification for subaxial cervical injuries should be used. The Canadian C-Spine Rule is recommended as a clinical decision rule whether to perform imaging or not. If a structural or unstable injury is suspected by patient history or clinical findings, a spiral CT scan of the cervical spine is the favoured diagnostic modality. Conventional X-ray is reserved for patients in whom there is no "dangerous mechanism of injury". MR imaging is recommended in case of unexplained neurologic deficit, prior to closed reduction and open posterior surgery and to exclude disco-ligamentous injuries. Urgency of MR imaging depends on the specific findings. CT angiography is recommended in higher-grade facet joint injuries or in the presence of vertebra-basilar symptoms. Flexion-extension imaging is recommended only as a physician-guided dynamic fluoroscopy, when an unstable lesion is still suspected. The therapeutic strategy is mainly dependent on morphologic criteria, which are described using the AOSpine classification. A0-injuries are treated conservatively. A1- and A2-injuries are treated conservatively in the majority of cases, and in single cases a gross kyphotic deformity might indicate surgical stabilisation. A3-injuries do indicate a surgical therapy in the majority of cases, but certain cases might be treated conservatively. A4-fractures as well as B- and C-type injuries are to be treated surgically. Most injuries can be treated by anterior plate stabilisation with interbody support; when a complete burst fracture is present, corpectomy and vertebral body replacement is necessary. In certain cases, an additive posterior or pure posterior instrumentation might be possible or even mandatory. In most of these cases, lateral mass screws are sufficient; when pedicle screws are applied in C3 to C6, a 3D-navigation system is recommended. Injuries in an ankylosing spine (M3-modifier) should be treated preferably from posterior with long-segment instrumentation.

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Reduction of traumatic dislocations and facet fracture-dislocations in the lower cervical spine

Cited by 16 publications

References 50 publications

Mid- to long-term outcome of instrumented anterior cervical fusion for subaxial injuries

Mid- to long-term outcome of instrumented anterior cervical fusion for subaxial injuries

Luxationsfrakturen der unteren HWS – dorsal beginnen!

Therapieempfehlungen zur Versorgung von Verletzungen der subaxialen Halswirbelsäule

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