title: Neglected dislocation in sub-axial cervical spine: Case series and a suggested treatment protocol.
abstract: BACKGROUND
  Approaches suggested for treatment of neglected dislocations in the subaxial cervical spine (SACS) include only anterior approach (a), only posterior approach (b), posterior-anterior approach, posterior-anterior-posterior approach, and anterior-posterior-anterior-posterior approach. No protocol is suggested in literature to guide surgeons treating neglected dislocations.
  
  
  OBJECTIVE
  To describe a protocol for the treatment of neglected dislocation in the SACS.
  
  
  METHODS
  Retrospective case series and review of literature.
  
  
  METHODS
  Six consecutive patients of neglected dislocation (presenting to us more than 3 weeks following trauma) of the SACS were operated as per the protocol suggested in this paper. A retrospective review of the occupational therapy reports, patient records, and radiographs was performed. Only cases with time lapse of more than 3 weeks between the time of injury and initial management have been included in the review.
  
  
  RESULTS
  Closed reduction (CR) was achieved in three patients following cervical traction and these were managed by anterior cervical discectomy and fusion (ACDF). Open reduction via posterior approach and soft tissue release was required to achieve reduction in two patients. Following reduction posterior instrumented fusion was done in them. One patient with preoperative neurological deficit needed a facetectomy to achieve reduction. Following short-segment fixation, ACDF was also performed in this patient. None of the patients deteriorated neurologically following surgery. Fusion was achieved in all patients.
  
  
  CONCLUSIONS
  Preoperative and intraoperative traction have a role in the management of neglected dislocations in the cervical spine. If CR is achieved the patient may be managed by ACDF. If CR is not achieved, posterior soft tissue release may be done to achieve reduction and partial facetectomy must be reserved for cases in which reduction is not achieved after soft tissue release. A treatment protocol for management of neglected dislocation in the SACS has been suggested in this paper.
authors.affiliation: Department of Orthopaedics, Seth G.S. Medical College and KEM Hospital, Mumbai, Maharashtra, India.
authors.forename: Sudhir Kumar
authors.initials: SK
authors.lastname: Srivastava
authors.affiliation: Department of Orthopaedics, Seth G.S. Medical College and KEM Hospital, Mumbai, Maharashtra, India.
authors.forename: Rishi Anil
authors.initials: RA
authors.lastname: Aggarwal
authors.affiliation: Department of Orthopaedics, Seth G.S. Medical College and KEM Hospital, Mumbai, Maharashtra, India.
authors.forename: Sunil Krishna
authors.initials: SK
authors.lastname: Bhosale
authors.affiliation: Department of Orthopaedics, Seth G.S. Medical College and KEM Hospital, Mumbai, Maharashtra, India.
authors.forename: Pradip Sharad
authors.initials: PS
authors.lastname: Nemade
keywords: Cervical spine; dislocation; neglected dislocation; sub-axial cervical spine; treatment protocol