Anterior Approach Following Intraoperative Reduction for Cervical Facet Fracture and Dislocation

Abstract

Objective: The purpose of this study was to evaluate the efficacy of the anterior approach following intraoperative reduction under general anesthesia in patients with cervical facet fracture and dislocation.

Methods: Twenty-three patients with single level cervical facet fracture and dislocation who were subjected to the anterior approach alone following immediate intraoperative reduction under general anesthesia from March 2013 to December 2017 were enrolled in this study. Neurological status, clinical outcome, and radiological studies were evaluated preoperatively, postoperatively, and during the follow-up period.

Results: The cohort comprised 15 men and eight women with a mean age of 57 years (from 24 to 81). All patients were operated on within the first 8 hours following the injury. After gentle manual reduction or closed reduction with Gardner-Wells traction, under general anesthesia monitored by somatosensory-evoked potentials, all operations were successfully completed using the anterior approach alone except in two patients, who had a risk of over-distraction. In them, a satisfactory gentle manual reduction or closed reduction was not possible, and required open posterior reduction of the locked facets followed by anterior cervical discectomy and fusion. In one patient, screw retropulsion was observed in 1 month after surgery. There were no reduction-related complications or neurological aggravations after surgery. All patients showed evidence of stability at the instrumented level at the final follow-up (mean follow-up, 12 months).

Conclusion: Anterior approach following intraoperative reduction monitored by somatosensory-evoked potentials under general anesthesia for cervical dislocation and locked facets is a relatively safe and effective alternative when cervical alignment is achieved by intraoperative reduction.

Keywords: Cervical vertebra; Fracture dislocation.

Fig. 1.

Representative images of a 45-year-old male patient. A : Simple lateral cervical radiograph demonstrates facet dislocation of C5–C6. B : Preoperative computed tomography scan shows facet interlocking at C5–C6 level. C and D : Good alignment is achieved after intraoperative manual reduction under general anesthesia. E : Postoperative lateral cervical radiograph shows good alignment after application of the anterior approach alone. F : Good alignment is still maintained after 12 months.

Fig. 2.

Representative images of a 57-year-old male patient. A : Preoperative computed tomography scan shows facet interlocking at C6–C7 level. B : Postoperative lateral cervical radiograph shows good alignment after intraoperative reduction under general anesthesia using posterior open reduction followed by the anterior discectomy and fusion. C : Postoperative computed tomography scan at 8 months after surgery reveals trabecular bone bridging and maintained good alignment.