Bony fusion in a chronic cervical bilateral facet dislocation

Cervical corpectomy in delayed presentation of irreducible cervical dislocation: experience with eight cases

OBJECTIVE

To describe a single-staged procedure for the management of neglected subaxial cervical spine injuries.

METHODS

Between January 2012 and December 2014, 12 patients presented to us with healed cervical sub axial dislocations. The deformities could not be reduced using skull traction. Eight were operated with anterior cervical corpectomy. American spinal injury Association (ASIA) grade, Neck Disability index (NDI), and Visual analog scale (VAS) score were recorded throughout the patient course and CT was done at 12 months for assessment of fusion.

RESULTS

Four patients improved from ASIA C to ASIA D, two patients improved from ASIA B to ASIA E, one patient improved from ASIA D to ASIA E and one patient remained static at ASIA B. All patients except one showed evidence of fusion on CT scan at 12 months. NDI improved from preoperative range (18-32, mean 25) to postoperative range (8-16 mean, 11.25), VAS from preoperative range (3-6, mean 4.25) to postoperative range (1-3, mean 1.75).

CONCLUSIONS

Single-stage in situ fixation does not disrupt ongoing natural healing and has good clinical and radiological outcomes.

Nonoperative Management of Chronically Subluxated Bilateral Cervical Facets with Bony Fusion: A Case Report

CASE

We describe a case of a 65-year-old woman with bilateral chronically subluxated C6 to 7 facets with facet fusion, who presented for care for the first time 1 year after a motor vehicle accident. The patient was minimally symptomatic at the time of her evaluation; thus, nonoperative treatment was provided. At 3-year follow-up, our patient remained minimally symptomatic with no progression of neurologic deficits.

CONCLUSION

Consistent with previous reports, conservative management was used rather than surgical fusion in a patient with stable osseous fusion complexes and minimal neurologic symptoms.

Neglected dislocation in sub-axial cervical spine: Case series and a suggested treatment protocol

Context:

Approaches suggested for treatment of neglected dislocations in the subaxial cervical spine (SACS) include only anterior approach (a), only posterior approach (b), posterior-anterior approach, posterior-anterior-posterior approach, and anterior-posterior-anterior-posterior approach. No protocol is suggested in literature to guide surgeons treating neglected dislocations.

Aim:

To describe a protocol for the treatment of neglected dislocation in the SACS.

Settings and Designs:

Retrospective case series and review of literature.

Materials and Methods:

Six consecutive patients of neglected dislocation (presenting to us more than 3 weeks following trauma) of the SACS were operated as per the protocol suggested in this paper. A retrospective review of the occupational therapy reports, patient records, and radiographs was performed. Only cases with time lapse of more than 3 weeks between the time of injury and initial management have been included in the review.

Results:

Closed reduction (CR) was achieved in three patients following cervical traction and these were managed by anterior cervical discectomy and fusion (ACDF). Open reduction via posterior approach and soft tissue release was required to achieve reduction in two patients. Following reduction posterior instrumented fusion was done in them. One patient with preoperative neurological deficit needed a facetectomy to achieve reduction. Following short-segment fixation, ACDF was also performed in this patient. None of the patients deteriorated neurologically following surgery. Fusion was achieved in all patients.

Conclusions:

Preoperative and intraoperative traction have a role in the management of neglected dislocations in the cervical spine. If CR is achieved the patient may be managed by ACDF. If CR is not achieved, posterior soft tissue release may be done to achieve reduction and partial facetectomy must be reserved for cases in which reduction is not achieved after soft tissue release. A treatment protocol for management of neglected dislocation in the SACS has been suggested in this paper.

Anterior Cervical Corpectomy Non-Fusion Model Produced by a Novel Implant

BACKGROUND

Anterior cervical corpectomy and fusion are frequently used in the treatment of cervical spinal disease. However, the range of motion (ROM) of the operative level is unavoidably lost due to fusion. This study aims to establish an anterior cervical corpectomy goat non-fusion model and to evaluate the ROM of adjacent and operative levels.

MATERIAL/METHODS

Six adult-male goats (in vivo group) and twelve adult-male goat cervical spine specimens (randomly divided equally into intact group or in vitro group) were included. The non-fusion model was established by implanting a novel implant at C4 level. Imagiological examinations for the in vivo group were performed to inspect the position of the implant and spinal cord status. Specimens were harvested six months after the operation. Biomechanical testing was conducted to obtain the ROM in flexion-extension, lateral bending, and axial rotation at upper adjacent level (C(2-3)), operative levels (C(3-4) and C(4-5)) and at C(2-5). Specimens in the intact group were first tested as intact and then tested as fixed and became the fixation group.

RESULTS

Imagiological examinations revealed that the position of the implant and the spinal cord status were good. The specimens in the in vivo and in vitro groups had significantly decreased C(2-3) ROM, increased C(3-4) and C(4-5) ROM and similar C(2-5) ROM compared with the fixation group.

CONCLUSIONS

This study presents a novel method for potential non-fusion treatment strategies for cervical spinal disease. However, improvement of this model and additional studies are needed.