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Yang Q, Yang ZC, Liu CX, Zeng H. Severe traumatic dislocation of the lower cervical spine with mild neurological symptoms: Case reports and literature review. J Spinal Cord Med 2024:1-7. [PMID: 38996215 DOI: 10.1080/10790268.2024.2374131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/14/2024] Open
Abstract
CONTEXT Severe traumatic fractures and dislocations of the lower cervical spine are usually accompanied by irreversible spinal cord injuries. Such patients rarely have mild or no neurological symptoms. FINDINGS We report three cases of severe lower cervical dislocation without spinal cord injury and discuss the mechanisms underlying this type of injury. All three patients had severe lower cervical dislocation, but their neurological symptoms were mild. In all cases, the fractures occurred at the bilateral junctions of the lamina and pedicle, resulting in severe cervical spondylolisthesis, whereas the posterior structure remained in place, thereby increasing the cross-sectional area of the spinal canal. After preoperative skull traction for a few days, the patients underwent anterior or combined anterior and posterior cervical surgeries. All surgeries were successfully completed and the patient's symptoms disappeared at the last follow-up. CONCLUSION Severe traumatic dislocation of the lower cervical spine with an intact neurological status is rare in clinical practice. Pathological canal enlargement preserves neurological function, and the most commonly injured segment is C7. Preoperative traction for closed reduction remains controversial. We suggest that if no obvious anterior compression is observed, closed reduction should be pursued. Anterior or combined anterior and posterior cervical surgeries can provide rigid fixation with satisfactory results.
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Affiliation(s)
- Qian Yang
- Department of Nephrology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Ze-Chuan Yang
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Chao-Xu Liu
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Heng Zeng
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
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Liu K, Zhang Z. Reduction of Lower Cervical Facet Dislocation: A Review of All Techniques. Neurospine 2023; 20:181-204. [PMID: 37016866 PMCID: PMC10080426 DOI: 10.14245/ns.2244852.426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 11/23/2022] [Indexed: 04/03/2023] Open
Abstract
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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Affiliation(s)
- Ke Liu
- Department of Orthopedics, Hospital of the 75th Group Army, Yunnan, China
| | - Zhengfeng Zhang
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, Chongqing, China
- Corresponding Author Zhengfeng Zhang Department of Orthopedics, Xinqiao Hospital, Army Medical University, 183 Xinqiao Street, Shapingba District, Chongqing 400037, China
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Totera JIC, Vargas GH, Martini IF, Romero MG, Bacciarini AU, Plaza JVB. Unilateral Cervical Facet Fractures: Relevance of Acute Disc Injury in Conservative Treatment Failure. Asian Spine J 2023; 17:30-36. [PMID: 35368175 PMCID: PMC9977972 DOI: 10.31616/asj.2021.0437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 01/25/2022] [Indexed: 11/23/2022] Open
Abstract
STUDY DESIGN Case-control study. PURPOSE Analyze association between imaging factors related to the failure of conservative treatment in isolated subaxial cervical facet fractures. OVERVIEW OF LITERATURE Facet fracture (F1, F2, and F3 AOSpine) may be stable or unstable depending on clinical and imaging variables, which are not well established. As a result, differences in fracture management lead to differences in surgical or conservative indications, and there is no evidence to predict conservative treatment failure. METHODS Patients were categorized into two groups: six patients (16.2%) with conservative treatment failure (defined as the appearance of neurological symptoms, listhesis >3.5 mm, kyphotic deformation >11°, and/or non-union), and 31 patients (83.7%) with successful conservative management (defined as complete consolidation confirmed by computed tomography [CT] at the 6-month followup). All participants were fitted with rigid collars of the Miami type, and standardized follow-up was performed until consolidation or failure. CT and magnetic resonance imaging (MRI) was used to examine imaging characteristics. Sagittal balance parameters were assessed using CT, and signs of acute disc injury, prevertebral edema, facet synovitis, and interspinous hyperintense signal were assessed using MRI. RESULTS Thirty-seven patients were diagnosed with unilateral cervical facet fractures between 2009 and 2020. In this sample, acute disc injury had a significative association to failure of conservative treatment in F2 and F3 AOSpine facet fractures, 100% of the failure group presented with traumatic disc injury compared to 9.7% of the successful group, for the other variables: prevertebral edema, 83.7% vs. 41.9%; facet synovitis, 100% vs. 77.4%; and interspinous hyperintensity, 71.4% vs. 38.7%, respectively. With conservative management, all F1 fractures healed successfully. Conservative treatment failed in 20% of F2 fractures and 50% of F3 fractures, respectively. In terms of cervical sagittal balance parameters, there were no significant differences between groups. CONCLUSIONS Conservative management was successful in all F1 fractures. In F2 and F3 types, there was a significant association between acute disc injury and conservative treatment failure.
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Affiliation(s)
- Juan Ignacio Cirillo Totera
- Division of Spine Surgery, Department of Orthopaedics, Hospital del Trabajador, Santiago,
Chile,Universidad de los Andes, Santiago,
Chile
| | - Gabriel Hernández Vargas
- Division of Spine Surgery, Department of Orthopaedics, AOSpine Center Chile, Hospital del Trabajador, Santiago,
Chile
| | - Ignacio Farías Martini
- Division of Spine Surgery, Department of Orthopaedics, AOSpine Center Chile, Hospital del Trabajador, Santiago,
Chile
| | - Marcos Gimbernat Romero
- Division of Spine Surgery, Department of Orthopaedics, Hospital del Trabajador, Santiago,
Chile
| | | | - José Vicente Ballesteros Plaza
- Division of Spine Surgery, Department of Orthopaedics, Hospital del Trabajador, Santiago,
Chile,Orthopaedic Surgery Residency Training Program, Universidad Nacional Andrés Bello, Santiago,
Chile
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The surgical treatment of subaxial acute cervical spine facet dislocations in adults: a systematic review and meta-analysis. Neurosurg Rev 2022; 45:2659-2669. [PMID: 35596874 DOI: 10.1007/s10143-022-01808-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 04/02/2022] [Accepted: 05/05/2022] [Indexed: 10/18/2022]
Abstract
Adult cervical spine traumatic facet joint dislocations occur when excessive traumatic forces displace the vertebrae's facets, leading to loss of joint congruence. Reduction requires either cranial traction or open surgical procedures. This study aims to appraise the effects of different surgical techniques in the treatment of subaxial cervical spine acute traumatic facet blocks in adults. This study was based on a systematic literature review and meta-analysis, registered in Prospero (CRD42021279249). The PICO question was composed of adults with acute cervical spine traumatic facet dislocations submitted to anterior or posterior surgical approaches, associated or not with cranial traction for reduction. Each surgical technique was compared to the other. The primary clinical outcomes included neurological improvement or worsening and surgical success/failure rates. The anterior approach without cranial traction was efficient in reducing facet displacements. Skull traction was an efficient and immediate method to achieve spine dislocation reductions. Differences were not present among techniques regarding neurological improvement. There were no surgical failures in patients operated on via the posterior approach. The need to decompress and stabilize the cervical spine can be achieved by anterior or posterior surgical approaches, and there is no clear answer as to which initial approach is superior to the other.
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5
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McDonald CL, Daniels AH, Anderson GA, Alsoof D, Kuris EO. Traumatic Cervical Facet Fractures and Dislocations. JBJS Rev 2022; 10:01874474-202205000-00005. [PMID: 35536995 DOI: 10.2106/jbjs.rvw.22.00023] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
» Flexion-distraction, axial loading, and rotational forces can cause various degrees of osseoligamentous disruption of the cervical spine, leading to traumatic cervical facet fractures and dislocations. » Low-energy forces lead to minimally displaced facet fractures that often can be treated with immobilization only. High-energy forces are more likely to cause unstable injuries with or without neurologic compromise, which may require surgical intervention. » The initial treatment of cervical facet injuries requires patient evaluation and management through the Advanced Trauma Life Support (ATLS) protocols, while definitive management varies based on the biomechanical components of the injury, the neurologic status of the patient, and additional patient factors. » Cervical facet injuries often require a multidisciplinary approach to optimize long-term functional outcomes and minimize serious complications.
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Affiliation(s)
- Christopher L McDonald
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island
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Buontempo MG, Imam N, Koerner J. Stand-Alone Interbody Cage to Treat Cervical Facet Dislocation: A Case Report. JBJS Case Connect 2022; 12:01709767-202203000-00011. [PMID: 35020634 DOI: 10.2106/jbjs.cc.21.00489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE We present a 36-year-old man who sustained a traumatic C5-6 unilateral facet dislocation without neurological deficit. The patient was treated with anterior diskectomy and fusion using a stand-alone interbody cage. CONCLUSION Current treatment of cervical facet dislocations (CFDs) in patients undergoing an anterior cervical diskectomy and fusion commonly makes use of plates with screw fixation and interbody grafts or cages to achieve spinal fusion after the diskectomy is performed. This report documents the successful treatment of a CFD with a stand-alone interbody cage.
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Affiliation(s)
- Michael G Buontempo
- Department of Orthopaedic Surgery, Hackensack Meridian School of Medicine, Nutley, New Jersey
| | - Nareena Imam
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Paramus, New Jersey
| | - John Koerner
- Department of Orthopaedic Surgery, Hackensack Meridian School of Medicine, Nutley, New Jersey.,Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Paramus, New Jersey
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Subaxial Spine Fractures: A Comparison of Patient-reported Outcomes and Complications Between Anterior and Posterior Surgery. Spine (Phila Pa 1976) 2021; 46:E926-E931. [PMID: 34384090 DOI: 10.1097/brs.0000000000003979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Observational study on prospectively collected data. OBJECTIVES The aim of this study was to compare long-term patient-reported outcomes and complications after anterior or posterior cervical spine surgery for subaxial fractures. SUMMARY OF BACKGROUND DATA There is no consensus in the literature regarding the optimal surgical approach when treating spine fractures in the subaxial region. METHODS A total of 200 individuals who had been treated with either anterior or posterior surgery due to a subaxial single segment, or single vertebra, injury between 2006 and 2016 and had at least 1 year follow-up were identified in the Swedish Spine register. Cases were matched 1:1 for age (±5 years). Outcomes were Neck Disability Index (NDI) and EQ-5D-3L, and reoperations, mortality, and surgeon- and patient-reported wound complications within 90 days. t Tests and χ2 tests were used statistical comparisons. RESULTS At follow-up, NDI was 23 (21) in the anterior group and 29 (21) in the posterior group (P = 0.07). EQ-5D-3L index was 0.62 (0.37) in the anterior group and 0.54 (0.39) in the posterior group (P = 0.13). Patient satisfaction was higher in the anterior group (89% vs. 73%, P = 0.03). No deaths occurred within the first 90 days after surgery, six individuals in the anterior group and three individuals in the posterior group were reoperated (P = 0.31), and five individuals in the anterior group and 24 in the posterior group suffered a wound infection (P < 0.001). CONCLUSION Anterior surgery and posterior surgery were associated with similar neck disability and general quality of life at follow-up, whereas anterior surgery was associated with higher patient satisfaction and lower infection rates.Level of Evidence: 3.
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Karamian BA, Schroeder GD, Holas M, Joaquim AF, Canseco JA, Rajasekaran S, Benneker LM, Kandziora F, Schnake KJ, Öner FC, Kepler CK, Vaccaro AR. Variation in global treatment for subaxial cervical spine isolated unilateral facet fractures. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 30:1635-1650. [PMID: 33797624 DOI: 10.1007/s00586-021-06818-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 02/23/2021] [Accepted: 03/14/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE To determine the variation in the global treatment practices for subaxial unilateral cervical spine facet fractures based on surgeon experience, practice setting, and surgical subspecialty. METHODS A survey was sent to 272 members of the AO Spine Subaxial Injury Classification System Validation Group worldwide. Questions surveyed surgeon preferences with regard to diagnostic work-up and treatment of fracture types F1-F3, according to the AO Spine Subaxial Cervical Spine Injury Classification System, with various associated neurologic injuries. RESULTS A total of 161 responses were received. Academic surgeons use the facet portion of the AO Spine classification system less frequently (61.6%) compared to hospital-employed and private practice surgeons (81.1% and 81.8%, respectively) (p = 0.029). The overall consensus was in favor of operative treatment for any facet fracture with radicular symptoms (N2) and for any fractures categorized as F2N2 and above. For F3N0 fractures, significantly less surgeons from Africa/Asia/Middle East (49%) and Europe (59.2%) chose operative treatment than from North/Latin/South America (74.1%) (p = 0.025). For F3N1 fractures, significantly less surgeons from Africa/Asia/Middle East (52%) and Europe (63.3%) recommended operative treatment than from North/Latin/South America (84.5%) (p = 0.001). More than 95% of surgeons included CT in their work-up of facet fractures, regardless of the type. No statistically significant differences were seen in the need for MRI to decide treatment. CONCLUSION Considerable agreement exists between surgeon preferences with regard to unilateral facet fracture management with few exceptions. F2N2 fracture subtypes and subtypes with radiculopathy (N2) appear to be the threshold for operative treatment.
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Affiliation(s)
- Brian A Karamian
- Department of Orthopaedic Surgery, Rothman Institute at Thomas Jefferson University Hospital, 925 Chestnut St, 5th Floor, Philadelphia, PA, 19107, USA.
| | - Gregory D Schroeder
- Department of Orthopaedic Surgery, Rothman Institute at Thomas Jefferson University Hospital, 925 Chestnut St, 5th Floor, Philadelphia, PA, 19107, USA
| | - Martin Holas
- Klinika Úrazovej Chirurgie SZU a FNsP F.D.Roosevelta, Banská Bystrica, Slovakia
| | - Andrei F Joaquim
- Neurosurgery Division, Department of Neurology, State University of Campinas, Campinas-Sao Paulo, Brazil
| | - Jose A Canseco
- Department of Orthopaedic Surgery, Rothman Institute at Thomas Jefferson University Hospital, 925 Chestnut St, 5th Floor, Philadelphia, PA, 19107, USA
| | | | - Lorin M Benneker
- Spine Service, Orthopaedic Department, Sonnenhofspital, Bern, Switzerland
| | - Frank Kandziora
- FK- Center for Spine Surgery and Neurotraumatology, BG Unfallklinik Frankfurt am Main, Frankfurt, Germany
| | - Klaus J Schnake
- Center for Spinal Surgery, Malteser Waldkrankenhaus St. Marien, Erlangen, Germany
| | | | - Christopher K Kepler
- Department of Orthopaedic Surgery, Rothman Institute at Thomas Jefferson University Hospital, 925 Chestnut St, 5th Floor, Philadelphia, PA, 19107, USA
| | - Alexander R Vaccaro
- Department of Orthopaedic Surgery, Rothman Institute at Thomas Jefferson University Hospital, 925 Chestnut St, 5th Floor, Philadelphia, PA, 19107, USA
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Canseco JA, Schroeder GD, Patel PD, Grasso G, Chang M, Kandziora F, Vialle EN, Oner FC, Schnake KJ, Dvorak MF, Chapman JR, Benneker LM, Rajasekaran S, Kepler CK, Vaccaro AR. Regional and experiential differences in surgeon preference for the treatment of cervical facet injuries: a case study survey with the AO Spine Cervical Classification Validation Group. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 30:517-523. [PMID: 32700126 DOI: 10.1007/s00586-020-06535-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 07/02/2020] [Accepted: 07/09/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE The management of cervical facet dislocation injuries remains controversial. The main purpose of this investigation was to identify whether a surgeon's geographic location or years in practice influences their preferred management of traumatic cervical facet dislocation injuries. METHODS A survey was sent to 272 AO Spine members across all geographic regions and with a variety of practice experience. The survey included clinical case scenarios of cervical facet dislocation injuries and asked responders to select preferences among various diagnostic and management options. RESULTS A total of 189 complete responses were received. Over 50% of responding surgeons in each region elected to initiate management of cervical facet dislocation injuries with an MRI, with 6 case exceptions. Overall, there was considerable agreement between American and European responders regarding management of these injuries, with only 3 cases exhibiting a significant difference. Additionally, results also exhibited considerable management agreement between those with ≤ 10 and > 10 years of practice experience, with only 2 case exceptions noted. CONCLUSION More than half of responders, regardless of geographical location or practice experience, identified MRI as a screening imaging modality when managing cervical facet dislocation injuries, regardless of the status of the spinal cord and prior to any additional intervention. Additionally, a majority of surgeons would elect an anterior approach for the surgical management of these injuries. The study found overall agreement in management preferences of cervical facet dislocation injuries around the globe.
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Affiliation(s)
- Jose A Canseco
- Rothman Orthopaedic Institute at Thomas Jefferson University, 925 Chestnut St, 5th Floor, Philadelphia, PA, 19107, USA.
| | - Gregory D Schroeder
- Rothman Orthopaedic Institute at Thomas Jefferson University, 925 Chestnut St, 5th Floor, Philadelphia, PA, 19107, USA
| | - Parthik D Patel
- Rothman Orthopaedic Institute at Thomas Jefferson University, 925 Chestnut St, 5th Floor, Philadelphia, PA, 19107, USA
| | - Giovanni Grasso
- Neurosurgical Unit, Department of Biomedicine, Neurosciences and Advance Diagnostics (BiND), University of Palermo, Palermo, Italy
| | - Michael Chang
- Rothman Orthopaedic Institute at Thomas Jefferson University, 925 Chestnut St, 5th Floor, Philadelphia, PA, 19107, USA
| | - Frank Kandziora
- Center for Spinal Surgery and Neurotraumatology, Berufsgenossenschaftliche Unfallklinik, Frankfurt am Main, Germany
| | | | | | | | | | | | | | | | - Christopher K Kepler
- Rothman Orthopaedic Institute at Thomas Jefferson University, 925 Chestnut St, 5th Floor, Philadelphia, PA, 19107, USA
| | - Alexander R Vaccaro
- Rothman Orthopaedic Institute at Thomas Jefferson University, 925 Chestnut St, 5th Floor, Philadelphia, PA, 19107, USA
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Sharif S, Ali MYJ, Sih IMY, Parthiban J, Alves ÓL. Subaxial Cervical Spine Injuries: WFNS Spine Committee Recommendations. Neurospine 2021; 17:737-758. [PMID: 33401854 PMCID: PMC7788423 DOI: 10.14245/ns.2040368.184] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 09/14/2020] [Indexed: 12/16/2022] Open
Abstract
To formulate specific guidelines for the recommendation of subaxial cervical spine injuries concerning classification, management, posttraumatic locked facets and vertebral artery injury. Computerized literature was searched on PubMed and google scholar database from 2009 to 2020. For classification, keywords “Sub Axial Cervical Spine Classification,” resulting in 22 articles related to subaxial cervical spine injury classification system (SLICS) system and 11 articles related to AO (Arbeitsgemeinschaft für Osteosynthesefragen, German for “Association for the Study of Internal Fixation”) Spine system. The literature search yielded 210 and 78 articles on “management of subaxial cervical spine injuries” and the role of “SLICS” and “AO Spine” respectively. Keywords “management of traumatic facet locks” were searched and closed reduction, traction, approaches and techniques were studied. “Vertebral artery injury and cervical fracture” exhibited 2,328 references from the last 15 years. The objective was to identify the appropriate diagnostic tests and optimal treatment. Up-to-date information was reviewed, and statements were produced to reach a consensus in 2 separate consensus meetings of World Federation of Neurosurgical Societies (WFNS) Spine Committee. The statements were voted and reached a positive or negative consensus using Delphi method. Based on the most relevant literature, panelists in Moscow consensus meeting conducted in May 2019 drafted the statements, and after a preliminary voting session, the consensus was identified on various statements. Another meeting was conducted at Peshawar in November 2019, where in addition to previous statements, few other statements were discussed and voted. Specific recommendations were then formulated guiding classification, management, locked facets and vertebral artery injuries. This review summarizes the WFNS Spine Committee recommendations on subaxial cervical spine injuries.
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Affiliation(s)
- Salman Sharif
- Department of Neurosurgery, Liaquat National Hospital & Medical College, Karachi, Pakistan
| | | | - Ibet Marie Y Sih
- Institute for the Neurosciences, St. Luke's Medical Center, University of the Philippines - Philippine General Hospital, Metro Manila, The Philippines
| | - Jutty Parthiban
- Department Neurosurgery and Spine Unit, Kovai Medical Center and Hospital, Coimbatore, India
| | - Óscar L Alves
- Department of Neurosurgery, Hospital Lusíadas, Porto, Portugal
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11
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Zileli M, Osorio-Fonseca E, Konovalov N, Cardenas-Jalabe C, Kaprovoy S, Mlyavykh S, Pogosyan A. Early Management of Cervical Spine Trauma: WFNS Spine Committee Recommendations. Neurospine 2021; 17:710-722. [PMID: 33401852 PMCID: PMC7788428 DOI: 10.14245/ns.2040282.141] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 09/06/2020] [Indexed: 12/12/2022] Open
Abstract
Epidemiology, prevention, early management of cervical spine trauma and it's reduction are the objectives of this review paper. A PubMed and MEDLINE search between 2009 and 2019 were conducted using keywords. Case reports, experimental studies, papers other than English language and and unrelated studies were excluded. Up-to-date information on epidemiology of spine trauma, prevention, early emergency management, transportation, and closed reduction were reviewed and statements were produced to reach a consensus in 2 separate consensus meeting of World Federation of Neurosurgical Societies (WFNS) Spine Committee. The statements were voted and reached a positive or negative consensus using Delphi method. Global incidence of traumatic spinal injury is higher in low- and middle-income countries. The most frequent reasons are road traffic accidents and falls. The incidence from low falls in the elderly are increasing in high-income countries due to ageing populations. Prevention needs legislative, engineering, educational, and social efforts that need common efforts of all society. Emergency care of the trauma patient, transportation, and in-hospital acute management should be planned by implementing detailed protocols to prevent further damage to the spinal cord. This review summarizes the WFNS Spine Committee recommendations on epidemiology, prevention, and early management of cervical spine injuries.
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Affiliation(s)
- Mehmet Zileli
- Department of Neurosurgery, Ege University, Izmir, Turkey
| | | | - Nikolay Konovalov
- N.N. Burdenko National Medical Research Center of Neurosurgery, Moscow, Russian Federation
| | | | - Stanislav Kaprovoy
- N.N. Burdenko National Medical Research Center of Neurosurgery, Moscow, Russian Federation
| | - Sergey Mlyavykh
- Trauma and Orthopedics Institute, Privolzhsky Research Medical University, Nizhniy Novgorod, Russian Federation
| | - Artur Pogosyan
- N.N. Burdenko National Medical Research Center of Neurosurgery, Moscow, Russian Federation
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Finger G, de Lima Cecchini AM, Sfreddo E, de Lima Cecchini FM, Martins OG, Bozko Cecchini TP, Teles AR, Falavigna A. Subaxial spine arthrodesis in patients with spine fractures and facet joint dislocations: Is magnetic resonance imaging required to determine the optimal surgical approach? Surg Neurol Int 2019; 10:239. [PMID: 31893140 PMCID: PMC6911680 DOI: 10.25259/sni_512_2019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 11/13/2019] [Indexed: 11/12/2022] Open
Abstract
Background: The medical literature suggests that facet dislocations (FDs) must be managed surgically, even in the absence of spinal cord injury. In fact, there is no standard guideline for managing FD cases and whether magnetic resonance imaging (MRI) should be utilized for optimizing treatment planning. Methods: Fifteen cases of FD were evaluated twice by nine spine surgeons. The first assessment included computed tomography (CT) images only. Secondarily, original CT studies were supplemented with MRI. In each case, the participating surgeon had to acknowledge whether and what surgical treatment they would offer. Data for the two responses from all nine surgeons were then compared. Results: Based on CT images alone, there was no consensus regarding treatment choices in 13 cases, and a trend toward consensus in just two instances (κ = 0.01). When MRI scans were added to CT studies, among the 15 cases evaluated, 10 cases demonstrated a trend toward consensus, and in 1 case consensus was achieved. The Kappa interpersonal agreement based on MRI was 0.13. The analysis of the answers by each contributor in each case demonstrated that in 58.51% of cases the surgical treatment options were changed when analyzed by CT + MRI, in comparison to the options indicated based on CT alone. Conclusion: It appears that obtaining an MRI in addition to a CT before spine surgery for FD is essential mandatory, as it changed the treatment option in nearly 60% of cases.
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Affiliation(s)
- Guilherme Finger
- Department of Neurosurgery, Cristo Redentor Hospital, Porto Alegre, Brazil
| | | | - Ericson Sfreddo
- Department of Neurosurgery, Cristo Redentor Hospital, Porto Alegre, Brazil
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13
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Pehler S, Jones R, Staggers JR, Antonetti J, McGwin G, Theiss SM. Clinical Outcomes of Cervical Facet Fractures Treated Nonoperatively With Hard Collar or Halo Immobilization. Global Spine J 2019; 9:48-54. [PMID: 30775208 PMCID: PMC6362546 DOI: 10.1177/2192568218771911] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
STUDY DESIGN Retrospective review. OBJECTIVES To evaluate the rate of nonoperative treatment failure for cervical facet fractures while secondarily validating computed tomography-based criteria proposed by Spector et al for identifying risk of failure of nonoperative management. METHODS Single-level or multilevel unilateral cervical facet fractures from 2007 to 2014 were included. Exclusion criteria included spondylolisthesis, dislocated or perched facets, bilateral facet fractures at the same level, floating lateral mass, thoracic or lumbar spine injuries, or spinal cord injury. Patients were placed into 3 groups for evaluation: immediate operative management, successful nonoperative management, and failed nonoperative treatment requiring surgical intervention. RESULTS Eighty-eight patients (106 facets) were included. Twenty-one patients underwent operative treatment with anterior cervical discectomy and fusion or posterior spinal instrumentation and fusion without any failures. Sixty-seven of these patients were treated nonoperatively with either a hard collar (n = 62) or halo vest (n = 5). Eleven patients failed nonoperative treatment (16.4%), all with an absolute fracture height of at least 1 cm and 40% involvement of the absolute height of the lateral mass. Of the 56 patients successfully treated through nonoperative measures, 8 (14.3%) had fracture measurements exceeding both operative parameters. CONCLUSION We conclude that it is safe and appropriate for patients with unilateral cervical facet fractures to receive a trial period of nonoperative management. However, patients who weigh over 100 kg, have comminuted fractures, or have radiographic measurements outside of the proposed computed tomography criteria for nonoperative treatment should be educated on the risks of treatment failure.
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Affiliation(s)
| | - Ross Jones
- University of Alabama at Birmingham, AL, USA
| | - Jackson R. Staggers
- University of Alabama at Birmingham, AL, USA,Jackson R. Staggers, University of Alabama at Birmingham, 723 16th Ave S #723, Birmingham, AL 35205, USA.
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Branche MJ, Ozturk AK, Ramayya AG, McShane BJ, Schuster JM. Neurologic Status on Presentation as Predictive Measurement in Success of Closed Reduction in Traumatic Cervical Facet Fractures. World Neurosurg 2018. [PMID: 29530687 DOI: 10.1016/j.wneu.2018.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Dislocations to cervical facets resulting from traumatic injury often lead to neurologic impairment and can be treated both surgically and in a closed manner. OBJECTIVE We sought to evaluate the utilization of closed reduction in the initial management of bilateral facet dislocations over the past 10 years at our institution. METHODS We retrospectively reviewed the charts of patients who experienced subaxial cervical facet injury within the Penn Health System between 1 June 2006 and 1 June 2016 to identify patients with bilateral jumped/perched facets. The neurologic injury was identified on the basis of the American Spinal Injury Association (ASIA) spinal cord injury score. Analysis of variance and 2-sample t-tests were used to compare continuous distributions, and chi-square tests were used to compare categorical distributions. RESULTS We focused our analyses on patients who presented with bilateral jumped/perched facets with (ASIA A and B) or without (ASIA C, D, E) complete voluntary motor deficit and underwent attempted closed reduction. We found that the rate of successful closed reduction was significantly higher in incomplete motor deficits (5/5, P = 0.04, chi-square test) as compared with complete motor deficits (n = 2/11). CONCLUSION Our results demonstrate a significant difference in the success rate of closed reduction in patients with good neurologic status on presentation (ASIA A or B), compared with those with poor neurologic status (ASIA C, D, and E). These results suggest that closed reduction should be attempted in patients with good motor examinations on presentation, whereas those with significant deficits may benefit from earlier surgical intervention.
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Affiliation(s)
- Marc J Branche
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ali K Ozturk
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ashwin G Ramayya
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Brendan J McShane
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
| | - James M Schuster
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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15
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Botolin S, VanderHeiden TF, Moore EE, Fried H, Stahel PF. The role of pre-reduction MRI in the management of complex cervical spine fracture-dislocations: an ongoing controversy? Patient Saf Surg 2017; 11:23. [PMID: 28904564 PMCID: PMC5591568 DOI: 10.1186/s13037-017-0139-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 09/05/2017] [Indexed: 11/17/2022] Open
Abstract
Background Cervical spine fracture-dislocations in neurologically intact patients represent a surgical challenge due to the risk of inflicting iatrogenic spinal cord compression by closed reduction maneuvers. The use of MRI for early advanced imaging in these injuries remains controversially debated. Case presentation A 54-year old man sustained a fall over the handlebars of his racing bicycle. The helmeted patient sustained a fall on his head which resulted in a hyperflexion injury of the neck. He was neurologically intact on presentation. Initial CT imaging revealed a complex multisegmental cervical spine injury with a left-sided C6/C7 perched facet, a right sided C7/T1 fracture-dislocation, and a right-sided C6 and C7 traumatic laminotomy. The initial management consisted of temporary external Halo fixator application without closed reduction maneuver, to mitigate the risk of a delayed spinal cord injury. Subsequent advanced imaging by MRI revealed an acute traumatic C7/T1 disc herniation, with the intervertebral disc completely extruded into the spinal canal. Definitive surgical management was then accomplished by employing a three-stage anterior-posterior-anterior spinal decompression, realignment, fixation and fusion C4-T2 in one operative session. The patient recovered well and retained full neurological function. He resumed bicycle street racing within 10 months of the injury following successful spinal reconstruction. Conclusions The diagnostic evaluation of cervical fracture-dislocations should include advanced imaging by MRI in order to fully understand the injury pattern prior to proceeding with spinal reduction maneuvers which may impose the imminent threat of a devastating iatrogenic injury to the spinal cord. The presented staged management by initial Halo fixation without attempts for spinal reduction, followed by a surgical decompression and multilevel fusion, appears to represent a feasible and safe strategy for patients at risk of a delayed neurological injury.
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Affiliation(s)
- Sergiu Botolin
- Department of Orthopaedics, University of Colorado, School of Medicine and Denver Health Medical Center, 777 Bannock Street, Denver, CO 80204 USA
| | - Todd F VanderHeiden
- Department of Orthopaedics, University of Colorado, School of Medicine and Denver Health Medical Center, 777 Bannock Street, Denver, CO 80204 USA
| | - Ernest E Moore
- Department of Surgery, University of Colorado, School of Medicine and Denver Health Medical Center, Denver, CO 80204 USA
| | - Herbert Fried
- Department of Neurosurgery, University of Colorado, School of Medicine and Denver Health Medical Center, 777 Bannock Street, Denver, CO 80204 USA
| | - Philip F Stahel
- Department of Orthopaedics, University of Colorado, School of Medicine and Denver Health Medical Center, 777 Bannock Street, Denver, CO 80204 USA.,Department of Neurosurgery, University of Colorado, School of Medicine and Denver Health Medical Center, 777 Bannock Street, Denver, CO 80204 USA
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