When is the circumferential stabilization necessary for subaxial cervical fracture dislocations? The posterior ligament-bone injury classification and severity score: a novel treatment algorithm

Yang, Jun-Song; Liu, Peng; Liu, Tuan-Jiang; Zhang, Haiping; Zhang, Zhengping; Yan, Liang; Tuo, Yuan; Chen, Hao; Zou, Peng; Li, Qing-Da; Zhao, Yuan-Ting; Hao, Dingjun

doi:10.1007/s00586-020-06580-8

Cited by 5 publications

(4 citation statements)

References 31 publications

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“…Although there were many treatment strategies and algorithms in the past, 42,105,106 the optimum treatment strategy and algorithm of cervical facet dislocation is still a matter of debate (Fig. 17).…”

Section: Discussionmentioning

confidence: 99%

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

Liu¹

2023

Neurospine

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Objective: The surgical treatment of lower cervical facet dislocation is controversial. Great advancements on reduction techniques for lower cervical facet dislocation have been made in the past decades. However, there is no article reviewing all the reduction techniques yet. The aim is to review the evolution and advancements of the reduction techniques for lower cervical facet dislocation.Methods: The application of all reduction techniques for lower cervical facet dislocation, including closed reduction, anterior-only, posterior-only, and combined approach reduction, is reviewed and discussed. Recent advancements on the novel techniques of reduction are also described. The principles of various techniques for reduction of cervical facet dislocation are described in detail.Results: All reduction techniques are useful. The anterior-only surgical approach appears to be the most popular approach. Moreover, many novel or modified reduction and fixation methods have been introduced in recent years.Conclusion: The selection of surgical approach depends on a combination of factors, including surgeon preference, patient factors, injury morphology, and inherent advantages and disadvantages of any given approach.

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Section: Discussionmentioning

confidence: 99%

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

Liu¹

2023

Neurospine

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“…Запропоновану авторами схему оцінки застосовували у пацієнтів з показниками >4 балів за шкалою SLIC, тобто в усіх випадках рекомендовано хірургічне втручання [51]. На відміну від наведених раніше робіт Y. Kotani абсолютну перевагу віддано ACDF.…”

Section: тяжке ушкодженняunclassified

The classifications of subaxial cervical spine traumatic injuries. Part 5. Facet joint and lateral mass lesions

Nekhlopochyn¹,

Слынько²,

Verbov³

2021

Ukr Neurosurg J

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Traumatic injury to the cervical spine accompanied by a wide range of possible changes in its osteo-ligamentous apparatus. One of the basic criteria to determine the treatment strategy is the assessment of injury stability which depends on the condition of the spine supporting columns. Most of the modern and widely used classifications of subaxial cervical spine traumatic injuries quite sufficiently characterize the state of the anterior support column. At the same time, much less attention is paid to the assessment of the degree and nature of traumatic changes in lateral masses, facet joints, as well as possible dislocations. Literature analysis reveals the absence of a generally accepted scheme that would allow one to unambiguously and comprehensively characterize the damage to the facets / lateral masses and choose the optimal surgical or conservative treatment method. This review provides well known assessment schemes: classification of traumatic changes of facet joints by Marcel F. Dvorak et al., variants of traumatic displacement of the cervical vertebrae by V.P. Selivanov, variants of lateral mass traumatic injury by Y. Kotani et al. and Posterior Ligament-Bone Injury Classification and Severity Score. The advantages and disadvantages of anterior, posterior or combined approach for the treatment of traumatic injuries of posterior support complex are considered that is of critical importance for obtaining better clinical results. It is noted that the choice of the optimal treatment method is currently a controversial issue. Although good surgical results can be obtained using a variety of methods, there are certain situations in which one technique may be better than others. The accumulated clinical experience and current research on the injured spine biomechanics demonstrate the advantage of surgical treatment in most patients, since such injuries are usually unstable or potentially unstable.

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“…Это повлекло за собой поиск альтернативных методов стабилизации [3]. Концепция погружного остео-синтеза, в частности применение передних шейных пластин, позволила совершить революцию в этом направлении путем значительного снижения частоты послеоперационных осложнений, несмотря на появление специфических для каждой генерации пластин осложнений, связанных с дизайном и биомеханикой стабилизации [4]. По данным литературы [1,3,5], эффективность изолированной передней шейной стабилизации пластиной при переломовывихах составляет 75-100 %.…”

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“…С момента первых публикаций об эффективности применения передних шейных пластин при травматических дислокациях на субаксиальном уровне авторы публикаций [1,6,7] стали отмечать у ряда пациентов случаи релюксации, редислокации позвонков в условиях проведенной инструментальной стабилизации. Анализ литературы показал, что причинами потери интраоперационно достигнутой коррекции авторы исследований считали низкую высоту межтелового графта [1], перелом нижележащего тела позвонка [6,8], перелом суставного отростка [6], билатеральный характер вывиха [9], остеопороз [7], высокий риск на уровне С 6 -С 7 [3], степень повреждения заднего опорного комплекса [4,7], степень листеза [10], недостаток техники операции [1], особенности параметров шейного сагиттального баланса, перелом суставных отростков [11]. Дизайн большинства исследований ретроспективный, исследования построены на малых выборках.…”

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Biomechanical aspects of the initial stability of instrumental fixation in the treatment of subaxial cervical dislocations: an experimental study

et al. 2021

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Objective. To study the influence of thoracic inlet angle (TIA) and the fracture of the articular process on the initial strength of the fixation of the spinal segment during its anterior and circular instrumental surgical stabilization in an experiment on a model of the lower cervical spinal segment.Material and Methods. The material of the study was assembled models of C6–C7 spinal segments made using addictive technologies by 3D printing. After preliminary instrumentation, spinal segments were installed on the stand testing machine using specially manufactured equipment. A metered axial load simulating the native one was applied along the axis of the parameters SVA COG–C7 and C2–C7 SVA, which values were close to the value of 20 mm, at a rate of 1 mm/min until the shear strain was reached. The system’s resistance to displacement was measured, and the resulting load was evaluated. Four study groups were formed depending on the modeling of the T1 slope parameter, the integrity of the facets, and the type of instrumentation. Three tests were conducted in each group. The graphical curves were analyzed, and the values of the parameters of the neutral and elastic zones, the yield point, time to yield point, and the value of the applied load for the implementation of shear displacement were recorded. The data were subjected to comparative analysis.Results. In Group 1, anterior shear displacement of the C6 vertebra could not be induced in all series. In groups 2, 3, and 4 a shear displacement of ≥4 mm was noted in all series. In Group 3 where a fracture of the articular process was additionally modeled, the average value of the yield point was 423.5 ± 46.8 N. Elastic zone, the time to the onset of the yield point, the time at the end point or at a shear of C6 ≥4 mm did not differ significantly. In Group 4, a translational displacement of ≥4 mm was observed, though the average yield point was 1536.0 ± 40.0 N.Conclusion. The direction of the load applied to the fixed spinal segment, as well as the presence of damage to the articular processes, play a crucial role in maintaining resistance to shear deformation of the spinal segment during its instrumental stabilization. At high values of TIA (T1 slope) and the presence of fractures of the articular processes, the isolated anterior stabilization is less effective, circular fixation of 360° under these conditions gives a high initial stability to the spinal segment.

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When is the circumferential stabilization necessary for subaxial cervical fracture dislocations? The posterior ligament-bone injury classification and severity score: a novel treatment algorithm

Cited by 5 publications

References 31 publications

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

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

The classifications of subaxial cervical spine traumatic injuries. Part 5. Facet joint and lateral mass lesions

Biomechanical aspects of the initial stability of instrumental fixation in the treatment of subaxial cervical dislocations: an experimental study

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