title: Treatment of traumatic spondylolisthesis of the lower cervical spine with concomitant bilateral facet dislocations: risk of respiratory deterioration.
abstract: BACKGROUND
  This study aimed to retrospectively examine 36 cases of bilateral cervical facet dislocations (BCFD) of the lower cervical spine who were at risk for respiratory deterioration.
  
  
  METHODS
  The cases of 36 subjects with BCFD of the lower cervical spine who failed to achieve closed reduction were retrospectively studied. The extents of neurological injuries included posterior neck pain without neurological deficit (n=2), incomplete spinal cord injury (ISCI) (n=21), and complete spinal cord injury (CSCI) (n=13).
  
  
  RESULTS
  Among the subjects, 26 (72.22%) had dyspnea, 6 required mechanical ventilation due to respiratory muscle paralysis, 11 required tracheostomy, and 9 required intubation. All patients received posterior approach reduction, stabilization, and fusion treatment for BCFD in one operative session. For the 26 quadriparetic patients with dyspnea, priority was given to treating their respiratory problems. For the other 10 patients without dyspnea, surgical treatment for irreducible lower cervical spine dislocation was given priority. After an average follow-up period of 63 months, 21 complications were found, but all patients exhibited fusion. Twenty-one patients with ISCI exhibited improvements in their conditions of 1 or 2 grades on the American Spinal Injury Association scale, whereas those with CSCI did not improve. All 26 apnea cases improved. The majority (26) of the 36 cases with BCFD of the lower cervical spine suffered dyspnea.
  
  
  CONCLUSIONS
  Although further study is required, our study suggests that the posterior surgical approach to the cervical spine is safe and effective for patients with traumatic spondylolisthesis of the lower cervical spine concomitant with BCFD who are at risk of respiratory deterioration.
authors.affiliation: Department of Orthopedics, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.
authors.forename: Zhe-Wei
authors.initials: ZW
authors.lastname: Ye
authors.affiliation: Department of Orthopedics, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.
authors.forename: Shu-Hua
authors.initials: SH
authors.lastname: Yang
authors.affiliation: Department of Orthopedics, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.
authors.forename: Bao-Jun
authors.initials: BJ
authors.lastname: Chen
authors.affiliation: Department of Orthopedics, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.
authors.forename: Li-Ming
authors.initials: LM
authors.lastname: Xiong
authors.affiliation: Department of Orthopedics, Southwest Hospital, Third Military Medical University, Chongqing 400038, China.
authors.forename: Jian-Zhong
authors.initials: JZ
authors.lastname: Xu
authors.affiliation: Department of Orthopedics, Southwest Hospital, Third Military Medical University, Chongqing 400038, China. Electronic address: qingyihe.hq@gmail.com.
authors.forename: Qing-Yi
authors.initials: QY
authors.lastname: He
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D004204:Joint Dislocations / Q000150:complications / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012131:Respiratory Insufficiency / Q000209:etiology; D012189:Retrospective Studies; D012306:Risk; D018570:Risk Assessment; D013123:Spinal Fusion / Q000379:methods; D013124:Spinal Injuries / Q000601:surgery*; D013168:Spondylolisthesis / Q000150:complications / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult; D021801:Zygapophyseal Joint
keywords: Cervical facet dislocations; Posterior approach; Respiratory deterioration