Surgical approaches in advanced cervical trauma
Shaban, M., Hewedy, M. (2023). Surgical approaches in advanced cervical trauma. EKB Journal Management System, 4(2), 19-26. doi: 10.21608/ejmr.2023.198816.1364
Mohamed Shaban; Mohamed A Hewedy. "Surgical approaches in advanced cervical trauma". EKB Journal Management System, 4, 2, 2023, 19-26. doi: 10.21608/ejmr.2023.198816.1364
Shaban, M., Hewedy, M. (2023). 'Surgical approaches in advanced cervical trauma', EKB Journal Management System, 4(2), pp. 19-26. doi: 10.21608/ejmr.2023.198816.1364
Shaban, M., Hewedy, M. Surgical approaches in advanced cervical trauma. EKB Journal Management System, 2023; 4(2): 19-26. doi: 10.21608/ejmr.2023.198816.1364

Surgical approaches in advanced cervical trauma

Egyptian Journal of Medical Research
Volume 4, Issue 2, April 2023, Page 19-26  XML PDF (611.66 K)
Document Type: Original Article
DOI: 10.21608/ejmr.2023.198816.1364
View on SCiNiTO View on SCiNiTO
Authors
Mohamed Shaban email ; Mohamed A Hewedy
Department of Neurosurgery, Faculty of Medicine, Beni-Suef University, Egypt
Abstract
Background: Bilateral cervical facet dislocations present with severe neurological deficit and an unstable spine. Cervical dislocations with locked facets account for more than 50% of all cervical injuries. The rapid reduction should give the patient the best chance for neurological recovery from compression of the spinal cord or nerve root, or at least prevent progressive secondary spinal cord injury, however, the proper method for reduction and operation is still controversial. Purpose: To evaluate the surgical outcome in cervical spine injury with bilateral facet dislocation. Patients and Methods: In this study, all the records of sixteen patients with cervical bilateral facet dislocations were reviewed. The SLIC scoring was used for surgical decisions. These cases were managed in our department by open reduction and internal fixation from Jan 2018 to March 2020. Clinically we used the Frankel scale to evaluate our patients. Of our 16 patients, nine cases were managed by the anterior approach; four cases were managed by the posterior approach. And three cases needed a combined approach. Results: Mean age was 38 years. A road traffic accident was the cause of 80%. One patient had no neurological deficit. C5/6 and C 6/7 were the commonest injured segments (80%). Disc compression was present in 58% (eleven patients) of cases. The mean SLIC score was 8 and the mean hospital stay was 15 days. Restoring spinal alignment and reduction of facets was achieved in 87.5% (fourteen patients) of patients. Conclusion: Bilateral facet dislocation is a serious sequel to cervical spine trauma. It can present with the entire spectrum of neurological deficits. Patients with incomplete spinal cord injury show improvement after early decompression and fixation.
Keywords
Cervical trauma; bilateral locked facet; spinal fixation
References
  1. Alam N, Haque MR, Sarker AC, Kamaluddim M, Murshed A, Khan M: Cervical spinal injury: experience with 82 cases. International congress Series 1247: 591-596,2002
  2. Alexander R, Hulbert R J, Fisher C, Ronald A, Paul AD, Alpesh AP: The sub-axial cervical spine injury classification system (SLIC): a novel approach to recognize the importance of morphology, neurology and integrity of the disco-ligamentous complex. Spine32:2365-2374,2007
  3. Crawford N, Duggal N, Chamberlain RH: Unilateral cervical facet dislocation: injury mechanism and biomechanical consequences. Spine 27: 1858-1864,2002
  4. Ebraheim, Nabil A, Patil V, Liu J, Steve P, Richard A: Morphometric analysis of the superior facets and implications for facet dislocation.IntOrthop 32:97-101,2008
  5. Fazl M, Pirouzmand F: Intraoperative reduction of locked facets in the cervical spine by use of a modified interlaminar spreader: technical note. Neurosurgery 48: 444-446, 2001
  6. Lee J Y, Nassr A, Jason C, Joon Y, Alexander R: Controversies in the treatment of cervical spine dislocations. Spine Journal 9:418-423,2009
  7. Payer M, Schmidt: Management of traumatic bilateral locked facets of the subaxial cervical spine. Contemporary Neurosurgery 27:5-7,2005
  8. Payer M: Immediate open anterior reduction and anteroposteriofixation/fusion for bilateral cervical locked facet. - Acta neurochirurgica (Wien) 147: 509-514,2005
  9. Song KJ, Lee KB: Anterior versus combined anterior and posterior fixation/fusion in the treatment of distraction-flexion injury in the lower cervical spine. J Clin Neuroscience 15:36-42, 2008
  10. Scherping SC, Lauerman WC: Facet dislocations of the cervical spine.Semin Spine Surg 13: 2-10,2001
  11. Stellerman CB, Roy RS, Weiss MH: Cervical spine injuries; diagnosis and management. In: Wilkins RH, Rengachary SS, eds. Neurosurgery. New York: McGraw Hill:2875-2904,1996.
Statistics
Article View: 275
PDF Download: 160