Top

Journal of Orthopaedic Surgery and Research

Published in:

Open Access 01-12-2018 | Research article

Immediate reduction under general anesthesia and combined anterior and posterior fusion in the treatment of distraction-flexion injury in the lower cervical spine

Authors: De-chao Miao, Feng Wang, Yong Shen

Published in: Journal of Orthopaedic Surgery and Research | Issue 1/2018

Abstract

Background

Distraction-flexion of the lower cervical spine is a severe traumatic lesion, frequently resulting in paralysis. The optimal surgical treatment is controversial. It has been a challenge for orthopedic surgeons to manage distraction-flexion injury in the lower cervical spine while avoiding the risk of iatrogenic damage. Thus, safer strategies need to be designed and adopted.This study aimed to evaluate the clinical efficacy of immediate reduction under general anesthesia and combined anterior and posterior fusion in the treatment of distraction-flexion injury in the lower cervical spine.

Methods

Twenty-four subjects of traumatic lower cervical spinal distraction-flexion were retrospectively analyzed from January 2010 to December 2013. Traffic accident was the primary cause of injury, with patients presenting with dislocated segments in C4–5 (n = 8), C5–6 (n = 10), and C6–7 (n = 6). Sixteen patients had unilateral facet dislocation and eight had bilateral facet dislocation. Spinal injuries were classified according to the American Spinal Injury Association (ASIA) impairment scale (2000 edition amended), with four cases of grade A, four cases of grade B, ten cases of grade C, four cases of grade D, and two cases of grade E. On admission, all patients underwent immediate reduction under general anesthesia and combined anterior and posterior fusion. The mean follow-up time was 3.5 years.

Results

All operations were completed successfully, with no major complications. Postoperative X-rays showed satisfactory height for the cervical intervertebral space and recovery of the vertebral sequence. Bone fusion was completed within 4 to 6 months after surgery. Surgery also significantly improved neurological function in all patients.

Conclusion

Immediate reduction under general anesthesia and combined anterior and posterior fusion can be used to successfully treat distraction-flexion injury in the lower cervical spine, obtaining completed decompression, safe spinal re-alignment, and excellent immediate postoperative stability.

Maiman DJ, Barolat G, Larson SJ. Management of bilateral locked facets of the cervical spine. Neurosurgery. 1986;18(5):542–7.CrossRefPubMed

Eismont FJ, Arena MJ, Green BA. Extrusion of an intervertebral disc associated with traumatic subluxation or dislocation of cervical facets. Case report. J Bone Joint Surg Am. 1991;73(10):1555–60.CrossRefPubMed

Brodke DS, Anderson PA, Newell DW, Grady MS, Chapman JR. Comparison of anterior and posterior approaches in cervical spinal cord injuries. J Spinal Disord Tech. 2003;16(3):229–35.CrossRefPubMed

Fehlings MG, Sekhon LH, Tator C. The role and timing of decompression in acute spinal cord injury: what do we know? What should we do? Spine (Phila Pa 1976). 2001;26(24 Suppl):S101–10.CrossRef

Zhang Z, Liu C, Mu Z, et al. Anterior facetectomy for reduction of cervical facet dislocation. Spine (Phila Pa 1976). 2016;41(7):E403–9.CrossRef

Del CD, Tamaoki MJ, Martins DE, Puertas EB, Belloti JC. Surgical approaches for cervical spine facet dislocations in adults. Cochrane Database Syst Rev. 2014;10:CD008129.

Ordonez BJ, Benzel EC, Naderi S, Weller SJ. Cervical facet dislocation: techniques for ventral reduction and stabilization. J Neurosurg. 2000;92(1 Suppl):18–23.PubMed

Woodworth RS, Molinari WJ, Brandenstein D, Gruhn W, Molinari RW. Anterior cervical discectomy and fusion with structural allograft and plates for the treatment of unstable posterior cervical spine injuries. J Neurosurg Spine. 2009;10(2):93–101.CrossRefPubMed

Bracken MB, Shepard MJ, Collins WF, et al. A randomized, controlled trial of methylprednisolone or naloxone in the treatment of acute spinal-cord injury. Results of the Second National Acute Spinal Cord Injury Study. N Engl J Med. 1990;322(20):1405–11.CrossRefPubMed

10.

Brodke DS, Zdeblick TA. Modified Smith-Robinson procedure for anterior cervical discectomy and fusion. Spine (Phila Pa 1976). 1992;17(10 Suppl):S427–30.CrossRef

11.

Ivancic PC, Pearson AM, Tominaga Y, Simpson AK, Yue JJ, Panjabi MM. Mechanism of cervical spinal cord injury during bilateral facet dislocation. Spine (Phila Pa 1976). 2007;32(22):2467–73.CrossRef

12.

Aebi M. Surgical treatment of upper, middle and lower cervical injuries and non-unions by anterior procedures. Eur Spine J. 2010;19(Suppl 1):S33–9.CrossRefPubMed

13.

Jiang X, Yao Y, Yu M, Cao Y, Yang H. Surgical treatment for subaxial cervical facet dislocations with incomplete or without neurological deficit: a prospective study of 52 cases. Med Sci Monit. 2017;23:732–40.CrossRefPubMedPubMedCentral

14.

Lambiris E, Kasimatis GB, Tyllianakis M, Zouboulis P, Panagiotopoulos E. Treatment of unstable lower cervical spine injuries by anterior instrumented fusion alone. J Spinal Disord Tech. 2008;21(7):500–7.CrossRefPubMed

15.

Lee JY, Nassr A, Eck JC, Vaccaro AR. Controversies in the treatment of cervical spine dislocations. Spine J. 2009;9(5):418–23.CrossRefPubMed

16.

Payer M. Immediate open anterior reduction and antero-posterior fixation/fusion for bilateral cervical locked facets. Acta Neurochir (Wien). 2005;147(5):509–13. discussion 513–4CrossRef

17.

Hart RA. Cervical facet dislocation: when is magnetic resonance imaging indicated. Spine (Phila Pa 1976). 2002;27(1):116–7.CrossRef

18.

Miller LS, Cotler HB, De Lucia FA, Cotler JM, Hume EL. Biomechanical analysis of cervical distraction. Spine (Phila Pa 1976). 1987;12(9):831–7.CrossRef

19.

Onan OA, Heggeness MH, Hipp JA. A motion analysis of the cervical facet joint. Spine (Phila Pa 1976). 1998;23(4):430–9.CrossRef

20.

Vital JM, Gille O, Sénégas J, Pointillart V. Reduction technique for uni- and biarticular dislocations of the lower cervical spine. Spine (Phila Pa 1976). 1998;23(8):949–54. discussion 955CrossRef

21.

Hussain M, Nasir S, Murtaza G, Moeed U, Bari ME. Magnetic resonance imaging in cervical facet dislocation: a third world perspective. Asian Spine J. 2012;6(1):29–33.CrossRefPubMedPubMedCentral

22.

Song KJ, Lee KB. Anterior versus combined anterior and posterior fixation/fusion in the treatment of distraction-flexion injury in the lower cervical spine. J Clin Neurosci. 2008;15(1):36–42.CrossRefPubMed

23.

Maynard FM, Bracken MB, Creasey G, et al. International standards for neurological and functional classification of spinal cord injury. American Spinal Injury Association. Spinal Cord. 1997;35(5):266–74.PubMed

24.

Henriques T, Olerud C, Bergman A, Jónsson H. Distractive flexion injuries of the subaxial cervical spine treated with anterior plate alone. J Spinal Disord Tech. 2004;17(1):1–7.CrossRefPubMed

25.

Vaccaro AR, Madigan L, Schweitzer ME, Flanders AE, Hilibrand AS, Albert TJ. Magnetic resonance imaging analysis of soft tissue disruption after flexion-distraction injuries of the subaxial cervical spine. Spine (Phila Pa 1976). 2001;26(17):1866–72.CrossRef

26.

Pitzen T, Lane C, Goertzen D, et al. Anterior cervical plate fixation: biomechanical effectiveness as a function of posterior element injury. J Neurosurg. 2003;99(1 Suppl):84–90.PubMed

27.

Lins CC, Prado DT, Joaquim AF. Surgical treatment of traumatic cervical facet dislocation: anterior, posterior or combined approaches? Arq Neuropsiquiatr. 2016;74(9):745–9.CrossRefPubMed

28.

Belirgen M, Dlouhy BJ, Grossbach AJ, Torner JC, Hitchon PW. Surgical options in the treatment of subaxial cervical fractures: a retrospective cohort study. Clin Neurol Neurosurg. 2013;115(8):1420–8.CrossRefPubMed

29.

Nassr A, Lee JY, Dvorak MF, et al. Variations in surgical treatment of cervical facet dislocations. Spine (Phila Pa 1976). 2008;33(7):E188–93.CrossRef

30.

Shen Y, Shen HL, Feng ML, Zhang WB. Immediate reduction under general anesthesia and single-staged anteroposterior spinal reconstruction for fracture-dislocation of lower cervical spine. J Spinal Disord Tech. 2015;28(1):E1–8.CrossRefPubMed

31.

Walters BC, Hadley MN, Hurlbert RJ, et al. Guidelines for the management of acute cervical spine and spinal cord injuries: 2013 update. Neurosurgery. 2013;60(Suppl 1):82–91.CrossRefPubMed

32.

Mahale YJ, Silver JR, Henderson NJ. Neurological complications of the reduction of cervical spine dislocations. J Bone Joint Surg Br. 1993;75(3):403–9.CrossRefPubMed

33.

Lebl DR, Bono CM, Velmahos G, Metkar U, Nguyen J, Harris MB. Vertebral artery injury associated with blunt cervical spine trauma: a multivariate regression analysis. Spine (Phila Pa 1976). 2013;38(16):1352–61.CrossRef

34.

Nagata K, Inokuchi K, Chikuda H, et al. Early versus delayed reduction of cervical spine dislocation with complete motor paralysis: a multicenter study. Eur Spine J. 2017;26(4):1272–6.CrossRefPubMed

35.

Vaccaro AR, Daugherty RJ, Sheehan TP, et al. Neurologic outcome of early versus late surgery for cervical spinal cord injury. Spine (Phila Pa 1976). 1997;22(22):2609–13.CrossRef

36.

Vaccaro AR, Cook CM, McCullen G, Garfin SR. Cervical trauma: rationale for selecting the appropriate fusion technique. Orthop Clin North Am. 1998;29(4):745–54.CrossRefPubMed

37.

Takeshita K, Murakami M, Kobayashi A, Nakamura C. Relationship between cervical curvature index (Ishihara) and cervical spine angle (C2–7). J Orthop Sci. 2001;6(3):223–6.CrossRefPubMed

38.

Abumi K, Ito M, Sudo H. Reconstruction of the subaxial cervical spine using pedicle screw instrumentation. Spine (Phila Pa 1976). 2012;37(5):E349–56.CrossRef

39.

Du W, Wang L, Shen Y, Zhang Y, Ding W, Ren L. Long-term impacts of different posterior operations on curvature, neurological recovery and axial symptoms for multilevel cervical degenerative myelopathy. Eur Spine J. 2013;22(7):1594–602.CrossRefPubMedPubMedCentral

Title: Immediate reduction under general anesthesia and combined anterior and posterior fusion in the treatment of distraction-flexion injury in the lower cervical spine
Authors: De-chao Miao
Feng Wang
Yong Shen
Publication date: 01-12-2018
Publisher: BioMed Central
Published in: Journal of Orthopaedic Surgery and Research / Issue 1/2018
Electronic ISSN: 1749-799X
DOI: https://doi.org/10.1186/s13018-018-0842-x

ACC 2024 Congress

Springer Medicine

Immediate reduction under general anesthesia and combined anterior and posterior fusion in the treatment of distraction-flexion injury in the lower cervical spine

Abstract

Background

Methods

Results

Conclusion

ACC 2024 Congress

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2018

Association between SMAD3 gene polymorphisms and osteoarthritis risk: a systematic review and meta-analysis

Combined application of latissimus dorsi myocutaneous flap and iliac bone flap in the treatment of chronic osteomyelitis of the lower extremity

The distance of the femoral neurovascular bundle from the hip joint: an intraoperative guide to reduce iatrogenic injury

Supraspinatus tendon repair using anchors: a biomechanical evaluation in the rabbit

Traditional Chinese and western medicine for the prevention of deep venous thrombosis after lower extremity orthopedic surgery: a meta-analysis of randomized controlled trials

The potential effect of type 2 diabetes mellitus on lumbar disc degeneration: a retrospective single-center study