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Year : 2014  |  Volume : 62  |  Issue : 5  |  Page : 540--542

Delayed presentation of post-traumatic bilateral cervical facet dislocation: A series of 4 cases

Akash Mishra, Deepak Agrawal, PK Singh 
 Department of Neurosurgery, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India

Correspondence Address:
Deepak Agrawal
Department of Neurosurgery, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi
India




How to cite this article:
Mishra A, Agrawal D, Singh P K. Delayed presentation of post-traumatic bilateral cervical facet dislocation: A series of 4 cases.Neurol India 2014;62:540-542


How to cite this URL:
Mishra A, Agrawal D, Singh P K. Delayed presentation of post-traumatic bilateral cervical facet dislocation: A series of 4 cases. Neurol India [serial online] 2014 [cited 2022 Nov 30 ];62:540-542
Available from: https://www.neurologyindia.com/text.asp?2014/62/5/540/144454


Full Text

Sir,

Post-traumatic bilateral cervical facet dislocation of cervical spine results from hyperflexion injury and is considered as an unstable injury. Early management of these cases is required to prevent the impending neurological deficit. However in patients with delayed presentation there is progressive deformity and fusion which increases the surgical dilemma. We present our experience of four cases.

Between January 2013 and January 2014 four patients with cervical spine injuries were admitted with post-traumatic bilateral cervical facet dislocation. Medical records and operative procedure of all patients were reviewed. Cervical x-rays and computed tomography (CT) scans were done in the follow up period to evaluate correction of alignment [Figure 1],[Figure 2],[Figure 3] and [Figure 4] The neurological outcome was assessed using American spinal injury association (ASIA) scoring system [Table 1]. All patients except one were operated via posterior-anterior-posterior approach. In one patient [Figure 1] initial discectomy was done at C5-C6 level followed by posterior facetectomy and fusion. Finally polyetheretherketone (PEEK) cage placement and plating was done via anterior approach.{Figure 1}{Figure 2}{Figure 3}{Figure 4}{Table 1}

Delayed diagnosis of bilateral facet dislocation has been described as patients presenting more than three weeks. [1] to eight weeks. [2] after injury. Closed reduction by means of traction is successful only in 20% of patients presenting more than 72 hours after injury than in patients who present themselves earlier. [3] There are few cases in literature addressing the surgical dilemma posed by such cases [Table 2]. [4],[5],[6],[7] {Table 2}

Reduction in facet joint dislocations with accompanying intervertebral disc herniations should be performed after the herniated intervertebral discs have been removed through an anterior approach to prevent the exacerbation of neurologic symptoms. [8] If satisfactory results are achieved with a reduction after the removal of the herniated discs through an anterior approach, then an anterior fixation and fusion can be performed. However, in our experience, majority of cases have fibrous fusion of facets which may not be visible radiologically. This is the main cause of unsuccessful reduction and we recommend that all patients should be approached posteriorly first except when associated with extruded disc. Also, after partial facetectomy facets joints become mobile, forceful reduction at this stage should not be attempted as anterior compression might lead to neurological deterioration of the patient. In the second stage, gentle traction with anterior cervical discectomy and fusion (ACDF) may help in reduction of the residual listhesis. Traction is helpful intra-operatively as it reduces the listhesis and opens up the disc space for surgery. In conclusion, posterior-anterior-posterior approach may be appropriate for patients with delayed presentation of bilateral dislocation of facets except when complicated by extruded disc when an anterior-posterior-anterior approach may be more suitable.

References

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