Immediate open anterior reduction and antero-posterior fixation/fusion for bilateral cervical locked facets.
BACKGROUND
Bilateral cervical locked facets is a severe traumatic lesion, most frequently resulting in tetraplegia. The common treatment strategy has been an attempt of awake, closed reduction, adding general anesthesia, muscle relaxation and manual traction in difficult cases. In cases of failed closed reduction, open reduction has most commonly been performed by a posterior approach. Patients in the current series have been managed by immediate open anterior reduction and circumferential fixation/fusion. The technique is described and its potential advantages are discussed.


METHODS
Five consecutive patients with traumatic bilateral cervical locked facets are reported. The injury level was C4/5 in one and C5/6 in four patients. Four patients had initial tetraplegia, one patient was neurogically intact. All patients underwent immediate open anterior reduction by interbody distraction and gentle manual traction, followed by circumferential fixation/fusion. Mean follow-up was 15 months.


RESULTS
Immediate anterior open reduction was rapidly and reliably achieved in all five patients. No surgical complication occurred. All patients showed fusion at the three-month follow-up. All four tetraplegic patients regained at least one functional root level, but remained tetraplegic.


CONCLUSIONS
Immediate open anterior reduction of bilateral cervical locked facets and combined antero-posterior fixation/fusion was safe and reliable. This treatment strategy avoids time loss and patient discomfort from attempted closed reduction by traction, obviates the need for external immobilization, and results in an excellent fusion rate.
Payer
M
M
Department of Neurosurgery, University Hospital of Geneva, Geneva, Switzerland. mpayer@hotmail.com
D000368:Aged; D002574:Cervical Vertebrae / Q000293:injuries* / Q000473:pathology / Q000601:surgery*; D019299:Decompression, Surgical / Q000295:instrumentation / Q000379:methods; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D016268:Internal Fixators; D004204:Joint Dislocations / Q000150:complications / Q000473:pathology / Q000601:surgery*; D008022:Ligaments / Q000293:injuries / Q000473:pathology; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D011782:Quadriplegia / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D020127:Recovery of Function; D013119:Spinal Cord Injuries / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D013123:Spinal Fusion / Q000295:instrumentation / Q000379:methods*; D013124:Spinal Injuries / Q000150:complications / Q000473:pathology / Q000601:surgery*; D013126:Spinal Nerve Roots / Q000293:injuries / Q000503:physiopathology; D016896:Treatment Outcome; D021801:Zygapophyseal Joint / Q000293:injuries* / Q000473:pathology / Q000601:surgery*