title: Surgical approach in treatment of translation/rotation injuries of the lower cervical spine in 21 patients.
abstract: BACKGROUND
  The management of lower cervical spine injuries with a dislocation of one or both facet joints and a displacement of a vertebra over the adjacent stills generates considerable controversy. We describe our experience in surgical approach of these injuries.
  
  
  METHODS
  We present 21 cases treated between 2003-2010. Neurological status was evaluated with Frankel scale. Diagnosis was done by radiograph (XR), computed tomography (CT) and/or magnetic resonance image (MRI). Cervical traction was placed in 10 cases before surgery. Posterior and/or anterior approach was used for reduction and stabilization.
  
  
  RESULTS
  The 21 cases presented were treated by surgery. Posterior approach was initially used in 17 cases and complete reduction was achieved in 13 of them. The 4 cases where we only got a partial reduction, surgery had to be delayed for different reasons. Anterior approach was initially used in 4 of the 21 cases. In 3 of them, reduction was previously obtained by traction and the fourth case anterior approach was used initially due to an important spinal cord compression. Permanent stabilization was achieved in 19 of the 21 cases. In 1 of the other 2 cases an important deformity was detected after the anterior approach. The other case had a minimal progression after a posterior approach with no increase in successive check-ups. In the first 10 cases, we used traction before surgery but reduction was achieved only in 3 of them. As the number of cases increased we rather used posterior approach in the first place, without even trying a preoperative traction. There was no case of neurological deterioration after surgery.
  
  
  CONCLUSIONS
  Translation/rotation injuries of the lower cervical spine are unstable and surgical treatment must be indicated. It is our impression that posterior approach allows a better reduction and stabilization of this injuries and should be used initially without even trying a preoperative traction.
authors.affiliation: Unidad de Neurocirugía, Hospital Universitario de La Ribera, Alzira, Valencia, Spain.
authors.forename: Jose L
authors.initials: JL
authors.lastname: Llácer-Ortega
authors.forename: Pedro
authors.initials: P
authors.lastname: Riesgo-Suárez
authors.forename: Jose
authors.initials: J
authors.lastname: Piquer-Belloch
authors.forename: Vicente
authors.initials: V
authors.lastname: Rovira-Lillo
mesh_terms: D002574:Cervical Vertebrae / Q000601:surgery; D006801:Humans; D004204:Joint Dislocations; D012399:Rotation; D013117:Spinal Cord Compression; D014057:Tomography, X-Ray Computed