An anterior kyphotic paramedian distraction technique for reduction of cervical facet dislocation

English Keywords:Lower cervical spine  Cervical facet dislocation  Anterior reduction  Kyphotic paramedian distraction

English Abstract:

  【Abstract】 Objectives: To explore the clinical efficacy and safety of anterior kyphotic paramedian distraction technique for reduction of cervical facet dislocation. Methods: From January 2014 to December 2017, there were 63 cases of lower cervical facet dislocation which were treated by anterior kyphotic paramedian distraction technique in our hospital. There were 55 males and 8 females, with an average age of 48.8±12.2 years (range, 21 to 73 years). The injury segments were C3/4 in 4 cases, C4/5 in 9 cases, C5/6 in 26 cases, C6/7 in 22 cases, C7/T1 in 2 cases. Dislocation types were unilateral facet dislocation in 22 cases and bilateral facet dislocation in 41 cases. There were 18 cases with traumatic disc herniation, 20 cases with vertebra fracture and 14 cases with articular process fracture. The spinal cord injury grade(American Spinal Injury Association, ASIS) at admission was ASIA grade A in 17 cases, grade B in 3 cases, grade C in 3 cases, grade D in 23 cases, grade E in 17 cases. The preoperative time was from 3 to 64 days(average, 9.5±8.5 days), and follow-up ranged from 9 to 24 months (average, 15.7±5.1 months) after surgery. After successful reduction, cage with autogenous bone and anterior plate fixation were implanted. And then the success rate of reduction, operation time, intraoperative blood loss, the ASIA grade and fusion rate at the last follow-up were analyzed. Results: All the 63 patients were successfully treated. Fifty-two cases(82.5%) were directly reduced by anterior kyphotic paramedian distraction technique, including 22 cases of unilateral facet dislocation, 30 cases of bilateral facet dislocation, 15 cases with vertebra fracture and 7 cases with articular process fracture. The preoperation time was less than 2 weeks in 46 cases and 2-4 weeks in 6 cases. The mean operation time was 76.2±21.9 minutes and the mean blood loss was 66.3±37.0ml. The other 11 patients with failed reduction needed to be assisted with anterior facetectomy, and all of them were successfully reduced. At the last follow-up, 20(38.5%) of 52 patients with successful reduction by anterior kyphotic paramedian technique increased the ASIA grade by at least one grade(including 3 cases with preoperative grade A to grade B in 2 cases and grade C in 1 case at the last follow-up, 3 cases from grade C to grade D, 14 cases from grade D to grade E), and the other 32 cases remained ASIA grade unchanged（including 9 cases of grade A, 2 cases of grade B, 7 cases of grade C, 14 cases of grade E）. All patients achieved satisfactory fusion, and there was no implant failure. Conclusions: Anterior kyphotic paramedian distraction technique for reduction of lower cervical facet dislocation has the advantages of high success rate, simple operation, less trauma, safe and effective clinical result.