Treatment of cervical dislocation with locked facets.
BACKGROUND
Lower cervical dislocation with locked facets is common in cervical injury. The locked facets include unilateral and bilateral types. Different successful closed reduction rates has been achieved between unilateral and bilateral types by using rapid skull traction, which was commonly used to reduce the cervical dislocation. It is important to investigate a suitable management specific to patients with different types of cervical locked facets.


METHODS
A total of 38 patients with cervical dislocation with locked facet due to cervical injury treated by rapid skull traction and operation from 1988 to 2005 were reviewed. Rapid skull traction was used in all the patients. Successful closed reduction rate was 88.0% in patients with bilateral cervical locked facets and that was 15.4% in those with unilateral cervical locked facets. These data were then statistically compared by Chi-square test. Patients who were reduced successfully underwent anterior cervical discectomy and fusion at the injured level, and those who failed in closed reduction received posterior open reduction and fixation.


RESULTS
In this series, there was statistically significant difference (P < 0.05) in the rate of successful closed skull traction reduction between unilateral and bilateral locked facets dislocation. Unilateral cervical locked facets dislocation was not easily reduced by skull traction which was suitable for reduction of bilateral cervical locked facets dislocation. However, unilateral cervical locked facets dislocation can be reduced by posterior open reduction.


CONCLUSIONS
Unilateral cervical locked facets dislocation should be treated immediately with posterior open reduction and instrumentation. Bilateral cervical locked facets dislocation can be reduced by rapid skull traction firstly and anterior cervical discectomy and interbody fusion later.
Yu
Ze-sheng
ZS
Department of Orthopaedic Surgery, Peking University Third Hospital, Beijing 100083, China. zeshengyu@yahoo.com
Yue
James J
JJ
Wei
Feng
F
Liu
Zhong-jun
ZJ
Chen
Zhong-qiang
ZQ
Dang
Geng-ting
GT
D000328:Adult; D000368:Aged; D002574:Cervical Vertebrae / Q000293:injuries*; D017586:Diskectomy; D005260:Female; D006801:Humans; D004204:Joint Dislocations / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D013123:Spinal Fusion; D014143:Traction