Reduction, internal stabilization and anterior fusion in subaxial cervical dislocations
Keywords:
cervical vertebrae, neck injuries, spinal fusion, zygapophyseal jointAbstract
Introduction: cervical traumatic facet dislocations are frequent and require reduction, by closed or open methods. Surgical reduction can be performed by an anterior, posterior, or combined approach. The conduct to follow is controversial.
Objective: to evaluate the results of reduction, internal stabilization and fusion by anterior approach in subaxial cervical dislocations.
Methods: a non-randomized controlled quasi-experimental study was carried at the Holguin Clinical Surgical Hospital from November/2016 to August/2019. It worked with the entire population -27 patients- who met the selection criteria. The information was obtained from medical records and surgical reports. Various classifications and scales were used to evaluate the variables under study. Ethical principles were met.
Results: the male sex predominated (88.89 %), the group from 33 to 46 years (33.30 %) and the majority presented neurological lesions (92.60 %), six of them with complete lesions (22.20 %). The most affected level was C5-C6 (48.15 %). In 81.48 % the surgical intervention was performed in the first 24 hours and in 18.52 % within 48 hours. Discectomy was performed in 81.48 % and corpectomy in 18.52 %, both followed by fixation. Preoperative closed reduction was used in 22.22 %. During the fusion follow-up, 66.67 % achieved grade I at three months and 70.07 % at six.
Conclusions: intervention using this type of approach guarantees satisfactory vertebral fusion in the event of type C facet dislocations, without the need for a posterior approach.Downloads
References
Cochrane Database of Systematic Reviews, Issue 10, 2014. [base de datos en Internet]. Oxford: Update Software Ltd; 1998- [citado 12 Jun 2015]. Del Curto D, Tamaoki MJ, Martins DE, Puertas EB, Belloti JC. Surgical approaches for cervical spine facet dislocations in adults. (Revisión Cochrane): CD008129. [aprox. 32 p.]. Disponible en: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD008129.pub2/epdf/full
Zaveri G, Das G. Management of Sub-axial Cervical Spine Injuries. Indian J Orthop [Internet]. 2017 [citado 9 Nov 2021];51(6):633-52. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5688856/pdf/IJOrtho-51-633.pdf
Feuchtbaum E, Buchowski J, Zebala L. Subaxial cervical spine trauma. Curr Rev Musculoskelet Med [Internet]. diciembre de 2016 [citado 9 Nov 2021];9(4):496-504. Disponible en: https://link.springer.com/content/pdf/10.1007/s12178-016-9377-0.pdf
hoon-Park J, Woo-Roh S, Chul-Rhim S. A single-stage posterior approach with open reduction and pedicle screw fixation in subaxial cervical facet dislocations. J Neurosurg Spine [Internet]. 2015 [citado 9 Nov 2021];23(1):35-41. Disponible en: https://thejns.org/downloadpdf/journals/j-neurosurg-spine/23/1/article-p35.pdf
Mattiassich G, Gollwitzer M, Gaderer F, Blocher M, Osti M, Lill M, et al. Functional Outcomes in Individuals Undergoing Very Early (< 5 h) and Early (5–24 h) Surgical Decompression in Traumatic Cervical Spinal Cord Injury: Analysis of Neurological Improvement from the Austrian Spinal Cord Injury Study. J Neurotrauma [Internet]. 2017 [citado 9 Nov 2021];34(24):3362-71. Disponible en: https://www.liebertpub.com/doi/epdf/10.1089/neu.2017.5132
Li H, Huang Y, Cheng C, Lin Z, Wu D. Comparison of the technique of anterior cervical distraction and screw elevating-pulling reduction and conventional anterior cervical reduction technique for traumatic cervical spine fractures and dislocations. Int J Surg [Internet]. 2017 [citado 9 Nov 2021];40:45-51. Disponible en: https://reader.elsevier.com/reader/sd/pii/S1743919117301814?token=266594AF0C326ABC7B380EF42306C5DE1C3EC79DFBD49548C54A5B6B7EE8E93C5EC0E687A53E7D054FB91B4037B71ED4&originRegion=us-east-1&originCreation=20230209190610
Li H, Yong Z, Chen Z, Huang Y, Lin Z, Wu D. Anterior cervical distraction and screw elevating–pulling reduction for traumatic cervical spine fractures and dislocations. Medicine (Baltimore) [Internet]. 2017 [citado 9 Nov 2021];96(26):[aprox. 19 p.]. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5500047/
Wu Y, Shao X, Wang X, Zeng J. An Experimental Study on the Safety and Mechanism of Reduction of Subaxial Cervical Facet Dislocation Using Z-Shape Elevating-Pulling Reduction Technique. World Neurosurg. 2020;142:e364-71. Disponible en: https://www.sciencedirect.com/science/article/abs/pii/S1878875020315126
Gao W, Wang B, Hao D, Zhu Z, Guo H, Li H, et al. Surgical Treatment of Lower Cervical Fracture-Dislocation with Spinal Cord Injuries by Anterior Approach: 5- to 15-Year Follow-Up. World Neurosurg. [Internet]. 2018 [citado 9 Nov 2021];115:137-45. Disponible en: https://www.sciencedirect.com/science/article/abs/pii/S1878875018307058
Mullender MG, Huiskes R. Proposal for the regulatory mechanism of Wolff’s law. J Orthop Res [Internet]. 1995 [citado 9 Nov 2021];13(4):503-12. Disponible en: https://onlinelibrary.wiley.com/doi/abs/10.1002/jor.1100130405
Rizzolo SJ, Piazza MR, Cotler JM, Balderston RA, Schaeffer D, Flanders A. Intervertebral Disc Injury Complicating Cervical Spine Trauma. J Orthop Trauma [Internet]. 1990 [citado 9 Nov 2021];4(2):[aprox 1 p.]. Disponible en: https://journals.lww.com/jorthotrauma/Citation/1990/04020/Intervertebral_Disc_Injury_Complicating_Cervical.29.aspx
Reindl R, Ouellet J, Harvey EJ, Berry G, Arlet V. Anterior Reduction for Cervical Spine Dislocation. Spine [Internet]. 2006 [citado 9 Nov 2021];31(6):648-52. Disponible en: https://journals.lww.com/spinejournal/Abstract/2006/03150/Anterior_Reduction_for_Cervical_Spine_Dislocation.8.aspx
Sethy SS, Ahuja K, Ifthekar S, Sarkar B, Kandwal P. Is Anterior-Only Fixation Adequate for Three-Column Injuries of the Cervical Spine? Asian Spine J [Internet]. 2021 [citado 9 Nov 2021];15(1):72-80. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7904484/pdf/asj-2019-0225.pdf
Ren C, Qin R, Wang P, Wang P. Comparison of anterior and posterior approaches for treatment of traumatic cervical dislocation combined with spinal cord injury: Minimum 10-year follow-up. SciRep [Internet]. 2020 [citado 9 Nov 2021];10(1):[aprox. 8 p.]. Disponible en: https://www.nature.com/articles/s41598-020-67265-2.pdf
Kwon BK, Fisher CG, Boyd MC, Cobb J, Jebson H, Noonan V, et al. A prospective randomized controlled trial of anterior compared with posterior stabilization for unilateral facet injuries of the cervical spine. J Neurosurg Spine [Internet]. 2007 [citado 9 Nov 2021];7:1-12. Disponible en: https://thejns.org/spine/view/journals/j-neurosurg-spine/7/1/article-p1.xml
Do Koh Y, Lim T-H, Won You J, Eck J, An HS. A Biomechanical Comparison of Modern Anterior and Posterior Plate Fixation of the Cervical Spine. Spine [Internet]. 2001 [citado 9 Nov 2021]; 26(1):15-21. Disponible en: https://journals.lww.com/spinejournal/Abstract/2001/01010/A_Biomechanical_Comparison_of_Modern_Anterior_and.5.aspx
Oshina M, Oshima Y, Tanaka S, Riew KD. Radiological Fusion Criteria of Postoperative Anterior Cervical Discectomy and Fusion: A Systematic Review. Glob Spine J [Internet]. 2018 [citado 9 Nov 2021];8(7):739-50. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6232720/pdf/10.1177_2192568218755141.pdf
Noordhoek I, Koning MT, Vleggeert-Lankamp CLA. Evaluation of bony fusion after anterior cervical discectomy: a systematic literature review. Eur Spine J [Internet]. 2019 [citado 9 Nov 2021];28(2):386-99. Disponible en: https://link.springer.com/content/pdf/10.1007/s00586-018-5820-9.pdf
Kyung-Jin S, Su-Kyung L, Dong-Hun H, Yong-Jin K, Byung-Wan C. Limitation of previous Allen classification and subaxial cervical spine injury classification (SLIC) system in distractive-extension injury of cervical spine: proposal of modified classification system. Eur Spine J [Internet]. 2016 [citado 9 Nov 2021];25(1):74-9. Disponible en: https://link.springer.com/content/pdf/10.1007/s00586-015-4240-3.pdf
American Spinal Injury Association. International Standards for Neurological Classifications of Spinal Cord Injury. [Internet]. Chicago: American Spinal Injury Association; 2000. [citado 9 Nov 2021]. Disponible en: https://europepmc.org/backend/ptpmcrender.fcgi?accid=PMC8152171&blobtype=pdf
Schnake KJ, Schroeder GD, Vaccaro AR, Oner C. AOSpine Classification Systems (Subaxial, Thoracolumbar). J Orthop Trauma [Internet]. 2017 [citado 9 Nov 2021];31 Suppl 4:S14-23. Disponible en: https://pdfs.journals.lww.com/jorthotrauma/2017/09004/AOSpine_Classification_Systems__Subaxial,.3.pdf?token=method|ExpireAbsolute;source|Journals;ttl|1652741176846;payload|mY8D3u1TCCsNvP5E421JYK6N6XICDamxByyYpaNzk7FKjTaa1Yz22MivkHZqjGP4kdS2v0J76WGAnHACH69s21Csk0OpQi3YbjEMdSoz2UhVybFqQxA7lKwSUlA502zQZr96TQRwhVlocEp/sJ586aVbcBFlltKNKo+tbuMfL73hiPqJliudqs17cHeLcLbV/CqjlP3IO0jGHlHQtJWcICDdAyGJMnpi6RlbEJaRheGeh5z5uvqz3FLHgPKVXJzdN3T1YN5yP2+XHB1t+KPFgm8B128Z/33xtFvaH7cfpCFtNIVt0QEh4b/UC+dNqoMF;hash|zZWcVOllHMtDVXrH5nwXOQ
Bridwell KH, Lenke LG, McEnery KW, Baldus C, Blanke K. Anterior Fresh Frozen Structural Allografts in the Thoracic and Lumbar Spine: Do They Work If Combined With Posterior Fusion and Instrumentation in Adult Patients With Kyphosis or Anterior Column Defects? Spine. 1995;20(12):1410-8.
Asociación Médica Mundial. Declaración de Helsinki de la AMM. Principios éticos para las investigaciones médicas en seres humanos. Ratificada en la 64ª Asamblea General, Fortaleza, Brasil, octubre 2013. Helsinki: 18ª Asamblea Mundial; 1964 [citado 9 Nov 2021]. Disponible en: http://www.anmat.gov.ar/comunicados/HELSINSKI_2013.pdf
Satar A, Wazir Z, Saeed M, Arif M, Inam M. Early outcome of surgical intervention in subaxial cervical spine injuries. J Pak Med Assoc [Internet]. 2014 [citado 9 Nov 2021];64(12) Suppl 2):S83-86. Disponible en: https://www.jpma.org.pk/PdfDownloadsupplements/153
Quarrington RD, Jones CF, Tcherveniakov P, Clark JM, Sandler SJI, Lee YC, et al. Traumatic subaxial cervical facet subluxation and dislocation: epidemiology, radiographic analyses, and risk factors for spinal cord injury. Spine J [Internet]. 2018 [citado 9 Nov 2021];18(3):387-98. Disponibloe en: https://www.sciencedirect.com/science/article/abs/pii/S1529943017304965
Khanpara S, Ruiz-Pardo D, Spence SC, West OC, Riascos R. Incidence of cervical spine fractures on CT: a study in a large level I trauma center. Emerg Radiol [Internet]. 2020 [citado 9 Nov 2021];27(1):1-8. Disponible en: https://www.researchgate.net/profile/Shekhar-Khanpara/publication/335467386_Incidence_of_cervical_spine_fractures_on_CT_a_study_in_a_large_level_I_trauma_center/links/5f4fc229299bf13a3198dfdd/Incidence-of-cervical-spine-fractures-on-CT-a-study-in-a-large-level-I-trauma-center.pdf
Theodotou CB, Ghobrial GM, Middleton AL, Wang MY, Levi AD. Anterior Reduction and Fusion of Cervical Facet Dislocations. Neurosurgery [Internet]. 2019 [citado 9 Nov 2021];84(2):388-95. Disponible en: https://journals.lww.com/neurosurgery/Abstract/2019/02000/Anterior_Reduction_and_Fusion_of_Cervical_Facet.11.aspx
Liu K, Zhang Z. Comparison of a novel anterior-only approach and the conventional posterior–anterior approach for cervical facet dislocation: a retrospective study. Eur Spine J [Internet]. 2019 [citado 9 Nov 2021];28(10):2380-9. Disponible en: https://pubmed.ncbi.nlm.nih.gov/31332570/
Sharif S, Ali MYJ, Sih IMY, Parthiban J, Alves ÓL. Subaxial Cervical Spine Injuries: WFNS Spine Committee Recommendations. Neurospine [Internet]. 2020 [citado 9 Nov 2021];17(4):737-58. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7788423/
Lee W, Wong CC. Anterior-Alone Surgical Treatment for Subaxial Cervical Spine Facet Dislocation: A Systematic Review. Glob Spine J [Internet]. 2021 [citado 9 Nov 2021];11(2):256-65. Disponible en: https://journals.sagepub.com/doi/pdf/10.1177/2192568220907574
Shawky-Abdelgawaad A, Metry A, Elnady B, El Sheriff E. Anterior Cervical Reduction Decompression Fusion With Plating for Management of Traumatic Subaxial Cervical Spine Dislocations. Glob Spine J [Internet]. 2021 [citado 9 Nov 2021];11(3):312-20. Disponible en: https://journals.sagepub.com/doi/pdf/10.1177/2192568220903741
Wang TY, Mehta VA, Dalton T, Sankey EW, Rory Goodwin C, Karikari IO, et al. Biomechanics, evaluation, and management of subaxial cervical spine injuries: A comprehensive review of the literature. J Clin Neurosci [Internet]. 2021 [citado 9 Nov 2021];83:131-9. Disponible en: https://linkinghub.elsevier.com/retrieve/pii/S0967586820316209
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