The Management of Bilateral Interfacetal Dislocation with Anterior Fixation in Cervical Spine : Comparison with Combined Antero-Posterior Fixation

Kim, Ki Hong; Cho, Dae-Chul; Sung, Joo-Kyung

doi:10.3340/jkns.2007.42.4.305

Cited by 14 publications

(12 citation statements)

References 19 publications

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“…Achieving and maintaining a reduction of the facet joints is the most important factor when determining the correction of kyphosis deformity in cases of cervical fracture dislocations. These results are comparable to other studies evaluating the radiological outcomes of surgically managed patients with cervical fracture dislocations [14,16]. A facet reduction was achieved in all our patients, and follow-up imaging showed bony fusion in all our cases.…”

Section: Discussionsupporting

confidence: 88%

Is Anterior-Only Fixation Adequate for Three-Column Injuries of the Cervical Spine?

et al. 2021

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To analyze the clinical and functional outcomes of patients who have undergone anterior cervical discectomy/corpectomy and fusion (ACDF/ACCF) for a three-column cervical spine injury (CSI). Overview of Literature: The treatment of choice for a three-column CSI is an area of contention; however, combined anterior and posterior fixation is the preferred method explored in the literature. Studies have shown the superior biomechanical stability of posterior fixation over that of anterior fixation, but anterior-only approach in CSI has been proving its efficacy in recent times by providing reasonable stability with the maximum achievable decompression and fusion. Methods: Twenty-one patients undergoing ACDF/ACCF with a bone graft/metallic cage treatment for cervical injuries involving all three columns from January 2016 to July 2018 were included in the study. All of the patients were followed up monthly for the first 3 months and then every 6 months, until their last follow-up visit. Results: Nineteen patients had AO type C injuries and were managed with ACDF, and two patients with AO type B injuries were managed with ACCF. Fifteen had a complete spinal cord injury, while six had an incomplete spinal cord injury (American Spinal Injury Association B, C, and D). The mean segmental kyphosis at presentation of 12.2°±4.4° improved in the postoperative period to-7.2°±2.5°. At their final follow-up, all the patients showed clinical improvements when assessed by the Visual Analog Scale (6.8-1.8), Oswestry Disability Index score (59.7-34.9), and Spinal Cord Independence Measure score (24.8-36.4). One patient in the ACDF group needed a secondary posterior fixation because of instability. Conclusions: An anterior approach to the cervical spine in cervical fracture dislocations is an effective treatment showing an optimal recovery rate in terms of patient-reported outcomes and structural stability, with the added advantages of less blood loss and the fact that the technique requires less instrumentation.

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Section: Discussionsupporting

confidence: 88%

Is Anterior-Only Fixation Adequate for Three-Column Injuries of the Cervical Spine?

et al. 2021

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“…This could cause neurological deterioration, and the additional risk of anterior collapse of the disc space could lead to kyphotic deformity12). On the contrary, anterior fixation reduces the risk of catastrophic neurological complications and provides satisfactory stabilization for management of these injuries14,29). Additional plate fixation after ACDF could provide effective stabilization with the advantage of only one-motion segment fusion in cervical facet dislocation.…”

Section: Discussionmentioning

confidence: 99%

Polyetheretherketone Cage with Demineralized Bone Matrix Can Replace Iliac Crest Autografts for Anterior Cervical Discectomy and Fusion in Subaxial Cervical Spine Injuries

Kim

Lee

Jang

et al. 2017

J Korean Neurosurg Soc

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ObjectiveThis study aimed to compare the clinical and radiologic outcomes of patients with subaxial cervical injury who underwent anterior cervical discectomy and fusion (ACDF) with autologous iliac bone graft or polyetheretherketone (PEEK) cages using demineralized bone matrix (DBM).MethodsFrom January 2005 to December 2010, 70 patients who underwent one-level ACDF with plate fixation for post-traumatic subaxial cervical spinal injury in a single institution were retrospectively investigated. Autologous iliac crest grafts were used in 33 patients (Group I), whereas 37 patients underwent ACDF using a PEEK cage filled with DBM (Group II). Plain radiographs were used to assess bone fusion, interbody height (IBH), segmental angle (SA), overall cervical sagittal alignment (CSA, C2–7 angle), and development of adjacent segmental degeneration (ASD). Clinical outcome was assessed using a visual analog scale (VAS) for pain and Frankel grade.ResultsThe mean follow-up duration for patients in Group I and Group II was 28.9 and 25.4 months, respectively. All patients from both groups achieved solid fusion during the follow-up period. The IBH and SA of the fused segment and CSA in Group II were better maintained during the follow-up period. Nine patients in Group I and two patients in Group II developed radiologic ASD. There were no statistically significant differences in the VAS score and Frankel grade between the groups.ConclusionThis study showed that PEEK cage filled with DBM, and plate fixation is at least as safe and effective as ACDF using autograft, with good maintenance of cervical alignment. With advantages such as no donor site morbidity and no graft-related complications, PEEK cage filled with DBM, and plate fixation provide a promising surgical option for treating traumatic subaxial cervical spine injuries.

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“…4,7 The anterior approach is a familiar method and can be useful for the easy removal of herniated discs. 5,12,17,20,21 However, this approach is likely to be a better option when a closed reduction is successful. If the closed reduction fails or cannot be performed, then the possibility of failure of an open reduction and additional posterior surgery should be considered.…”

Section: Discussionmentioning

confidence: 99%

“…If the closed reduction fails or cannot be performed, then the possibility of failure of an open reduction and additional posterior surgery should be considered. 3,12,21 Thus, some surgeons recommend the use of an anterior buttress plate for easy reduction during the subsequent posterior approach. 3 By contrast, the posterior approach is advocated because of easy reduction and improved postoperative alignment.…”

Section: Discussionmentioning

confidence: 99%

A single-stage posterior approach with open reduction and pedicle screw fixation in subaxial cervical facet dislocations

Park

Roh

Rhim

2015

SPI

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OBJECT The optimal treatment for cervical facet dislocations is controversial, but the generally accepted process recommends an initial closed reduction with the next step determined according to the success of the closed reduction and the presence of traumatic disc herniation. This study aimed to show the efficacy of a posterior approach performed with an open reduction and pedicle screw fixation with removal of disc particles, if required, in the management of subaxial cervical dislocations. METHODS Between March 2012 and September 2013, 21 consecutive patients with cervical facet dislocations were enrolled. The affected levels were as follows: 4 at C3–4; 2 at C4–5; 5 at C5–6; and 10 at the C6–7 level. Seven patients had traumatic disc herniations. Closed reduction was not attempted; a prompt posterior cervical surgery was performed instead. After open reduction, pedicle screw fixation was performed. In cases with traumatic disc herniation, herniated disc fragments were excised via a posterolateral approach and successful decompressions were determined by postoperative MRI studies. Clinical outcomes were assessed using the American Spinal Injury Association (ASIA) grading system. Radiological outcomes were assessed by comparing the degree of subluxation and the angle of segmental lordosis between pre- and postoperative CT scans. RESULTS All patients improved neurologically. The mean segmental angles improved from 7.3° ± 8.68° to −5.9° ± 4.85°. The mean subluxation improved from 23.4% ± 16.52% to 2.6% ± 7.19%. Disc fragments were successfully removed from the 7 patients with herniated discs, as shown on MRI. CONCLUSIONS Open reduction followed by pedicle screw fixation or posterolateral removal of herniated disc fragments is a good treatment option for cervical facet dislocations.

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The Management of Bilateral Interfacetal Dislocation with Anterior Fixation in Cervical Spine : Comparison with Combined Antero-Posterior Fixation

Cited by 14 publications

References 19 publications

Is Anterior-Only Fixation Adequate for Three-Column Injuries of the Cervical Spine?

Is Anterior-Only Fixation Adequate for Three-Column Injuries of the Cervical Spine?

Polyetheretherketone Cage with Demineralized Bone Matrix Can Replace Iliac Crest Autografts for Anterior Cervical Discectomy and Fusion in Subaxial Cervical Spine Injuries

A single-stage posterior approach with open reduction and pedicle screw fixation in subaxial cervical facet dislocations

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