title: Anterior decompression and nonstructural bone grafting and posterior fixation for cervical facet dislocation with traumatic disc herniation.
abstract: METHODS
  A series study of patients with lower cervical facet dislocation accompanied by traumatic disc herniation treated with anterior decompression and nonstructural bone grafting and posterior fixation.
  
  
  OBJECTIVE
  To describe a surgical technique of anterior decompression and nonstructural bone grafting and posterior fixation and its clinical outcome in a group of patients with lower cervical facet dislocation accompanied by traumatic disc herniation.
  
  
  BACKGROUND
  The optimal treatment for lower cervical facet dislocation with a prolapsed disc is still controversial.
  
  
  METHODS
  After discectomy and endplate preparation, a layer of morselized cancellous bone grafts from the iliac crest was placed in the interspace, and held in appropriate sagittal position by 2 layers of gelatin sponge and carefully sutured longus colli muscle. The anterior wound was then closed. The posterior elements were exposed and the reduction was performed. Fluoroscopy was used during reduction maneuver to ensure that the graft was still in the appropriate position. A posterior fusion was performed and the posterior wound was closed.
  
  
  RESULTS
  Between January 2006 and February 2010, 21 patients with cervical facet dislocation accompanied by traumatic disc herniation (13 unilateral dislocations and 8 bilateral dislocations) were recruited for this study. All the patients completed at least 1-year follow-up. Average follow-up duration was 29 ± 3.5 months. Average Frankel scales were significantly improved at the end of follow-up, visual analogue scale decreased from 7.8 ± 1.2 before the operation to less than 1.6 ± 0.5 (P < 0.05) 6 months later. Kyposis was corrected from 17.7° ± 6.3° to 6.5° ± 4.1° (P < 0.05) and remained at 5.9° ± 4.2° (P > 0.05) 1 year later. The average subsidence of bone graft was 1.28 ± 0.16 mm at 12 months after the operation and remained 1.34 ± 0.20 mm at 36 months after the operation. All patients had consolidation of both anterior and posterior fusions. No cases of instrument failure occurred and no complications were attributed to the use of this technique.
  
  
  CONCLUSIONS
  Although further study based on injury types as well as long-term follow-up is still needed, anterior decompression and nonstructural bone grafting and posterior fixation provides a promising surgical option for treating cervical facet dislocation with traumatic disc herniation.
authors.affiliation: Department of Orthopedic, Sichuan University, West China Hospital, Chengdu, Sichuan, China.
authors.forename: Ganjun
authors.initials: G
authors.lastname: Feng
authors.forename: Ying
authors.initials: Y
authors.lastname: Hong
authors.forename: Li
authors.initials: L
authors.lastname: Li
authors.forename: Hao
authors.initials: H
authors.lastname: Liu
authors.forename: Fuxing
authors.initials: F
authors.lastname: Pei
authors.forename: Yueming
authors.initials: Y
authors.lastname: Song
authors.forename: Fuguo
authors.initials: F
authors.lastname: Huang
authors.forename: Chongqi
authors.initials: C
authors.lastname: Tu
authors.forename: Tao
authors.initials: T
authors.lastname: Li
authors.forename: Quan
authors.initials: Q
authors.lastname: Gong
authors.forename: Limin
authors.initials: L
authors.lastname: Liu
authors.forename: Jiancheng
authors.initials: J
authors.lastname: Zeng
authors.forename: Qingquan
authors.initials: Q
authors.lastname: Kong
authors.forename: Melanie
authors.initials: M
authors.lastname: Gupte
mesh_terms: D000293:Adolescent; D000328:Adult; D001696:Biomechanical Phenomena; D016025:Bone Transplantation / Q000009:adverse effects; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries / Q000503:physiopathology / Q000601:surgery*; D019299:Decompression, Surgical / Q000009:adverse effects; D017586:Diskectomy; D005260:Female; D006801:Humans; D007085:Ilium / Q000637:transplantation*; D007405:Intervertebral Disc Displacement / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D004204:Joint Dislocations / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D007738:Kyphosis / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011859:Radiography; D013123:Spinal Fusion / Q000009:adverse effects; D013124:Spinal Injuries / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult; D021801:Zygapophyseal Joint / Q000293:injuries / Q000503:physiopathology / Q000601:surgery*