title: A single-stage posterior approach with open reduction and pedicle screw fixation in subaxial cervical facet dislocations.
abstract: OBJECTIVE
  The optimal treatment for cervical facet dislocations is controversial, but the generally accepted process recommends an initial closed reduction with the next step determined according to the success of the closed reduction and the presence of traumatic disc herniation. This study aimed to show the efficacy of a posterior approach performed with an open reduction and pedicle screw fixation with removal of disc particles, if required, in the management of subaxial cervical dislocations.
  
  
  METHODS
  Between March 2012 and September 2013, 21 consecutive patients with cervical facet dislocations were enrolled. The affected levels were as follows: 4 at C3-4; 2 at C4-5; 5 at C5-6; and 10 at the C6-7 level. Seven patients had traumatic disc herniations. Closed reduction was not attempted; a prompt posterior cervical surgery was performed instead. After open reduction, pedicle screw fixation was performed. In cases with traumatic disc herniation, herniated disc fragments were excised via a posterolateral approach and successful decompressions were determined by postoperative MRI studies. Clinical outcomes were assessed using the American Spinal Injury Association (ASIA) grading system. Radiological outcomes were assessed by comparing the degree of subluxation and the angle of segmental lordosis between pre- and postoperative CT scans.
  
  
  RESULTS
  All patients improved neurologically. The mean segmental angles improved from 7.3° ± 8.68° to -5.9° ± 4.85°. The mean subluxation improved from 23.4% ± 16.52% to 2.6% ± 7.19%. Disc fragments were successfully removed from the 7 patients with herniated discs, as shown on MRI.
  
  
  CONCLUSIONS
  Open reduction followed by pedicle screw fixation or posterolateral removal of herniated disc fragments is a good treatment option for cervical facet dislocations.
authors.affiliation: Department of Neurological Surgery, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea; and.
authors.forename: Jin Hoon
authors.initials: JH
authors.lastname: Park
authors.affiliation: Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Sung Woo
authors.initials: SW
authors.lastname: Roh
authors.affiliation: Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Seung Chul
authors.initials: SC
authors.lastname: Rhim
mesh_terms: D000328:Adult; D001863:Bone Screws; D002574:Cervical Vertebrae / Q000293:injuries* / Q000601:surgery*; D019299:Decompression, Surgical; D005260:Female; D005593:Fracture Fixation, Internal / Q000295:instrumentation*; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures; D016103:Spinal Fractures / Q000601:surgery*; D014139:Tracheostomy; D016896:Treatment Outcome
keywords: AANS/CNS = American Association of Neurological Surgeons/Congress of Neurological Surgeons; ASIA = American Spinal Injury Association; VA = vertebral artery; cervical facet dislocation; cervical pedicle screw; closed reduction; disc herniation; open reduction; posterior approach; surgical technique