[Surgical strategy for severe cervical spine dislocations].
OBJECTIVE
To evaluate the rate of open reduction and surgical strategy of severe cervical dislocation.


METHODS
From March 2001 to March 2006, the data of 92 cases of cervical dislocation over 1/2 were retrospectively studied. Garden Well traction with 1 - 3 kg weight were performed before operation. The patients were performed with diskectomy and reduction with anterior approach initially, for those that can not be reduced, corpectomy were performed and reduction procedures were repeated. The posterior reduction and fixation were followed when reduction can not be reached with anterior approach only. The succeed rate of reduction, rate of tracheotomy were recorded and fusion rate, Frankel score and visual analog scale (VAS) were evaluated.


RESULTS
Reduction succeed in 38 cases after diskectomy, 44 after corpectomy and 7 after combined anterior-posterior-anterior procedure. Three cases got incompleteness reduction. Tracheotomy was done in 29 cases. The Frankel score increased 0.5 degree and VAS was 2 averagely at the last follow-up.


CONCLUSIONS
The succeed rate of anterior open reduction was 89.2%, and only 10.8% patients needs an additional combined posterior and anterior approach. For patients with completed spinal cord injury with dislocation above C(4), or with dislocation below C(5) but the edema on MRI T2 image are above C(4) level need tracheotomy. The operation be done until respiratory function stable. For patients with completed spinal cord injury with dislocation below C(4) and uncompleted spinal cord injury with dislocation above C(4), the rate of tracheotomy is relatively lower and early operation is recommended.
Wang
Xin-wei
XW
Department of Orthopedics, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China.
Yuan
Wen
W
Chen
De-yu
DY
Chen
Xiong-sheng
XS
Zhou
Xu-hui
XH
Ye
Xiao-jian
XJ
Chen
Hua-jiang
HJ
Han
Zhu
Z
Kang
Jian
J
D016025:Bone Transplantation; D002574:Cervical Vertebrae / Q000293:injuries*; D019299:Decompression, Surgical / Q000379:methods*; D017586:Diskectomy; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000379:methods*; D006801:Humans; D004204:Joint Dislocations / Q000150:complications / Q000601:surgery*; D007796:Laminectomy; D008297:Male; D012189:Retrospective Studies; D016103:Spinal Fractures / Q000150:complications / Q000601:surgery*; D013123:Spinal Fusion; D014143:Traction; D016896:Treatment Outcome