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Management of Subaxial Cervical Facet Dislocation Through Anterior Approach Monitored by Spinal Cord Evoked Potential

Du, Wei, MD*,†; Wang, Cheng, MD*; Tan, Jiangwei, MD; Shen, Binghua, BA; Ni, Shuqin, BA; Zheng, Yanping, MD*

doi: 10.1097/BRS.0000000000000046
Cervical Spine
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Study Design. Retrospective case series.

Objective. To discuss the clinical efficacy of anterior cervical surgery of decompression, reduction, stabilization, and fusion in treating subaxial cervical facet dislocation without spinal cord injury or with mild spinal cord injury monitored by spinal cord evoked potential.

Summary of Background Data. The optimal treatment of lower cervical facet dislocation has been controversial. Because of the risk of iatrogenic damage of neurological function, it is challenging for surgeons to manage the lower cervical facet dislocation without or with mild spinal cord injury. To avoid the risks, more secure strategy need to be designed.

Methods. A retrospective study was performed on 17 cases of subaxial cervical facet dislocation without spinal cord injury or with mild spinal cord injury treated by anterior cervical surgery under spinal cord evoked potential monitor from January 2008 to June 2012. There were 12 males, 5 females, with a mean age of 40.1 years (from 21 to 73 yr). Dislocation sites: 1 in C3–C4, 2 in C4–C5, 6 in C5–C6, 8 in C6–C7; 10 cases with unilateral cervical facet dislocation, 7 cases with bilateral dislocation. Thirteen patients were preoperatively classified as grade D and 4 as E according to Frankel standard. All patients were followed up for average of 16 months.

Results. All operations were completed successfully. Postoperative radiographs showed that the sequence and curvature of the cervical spine were well recovered. And, evidence of intervertebral fusion was observed at 3 months in all cases. No redislocation or symptoms of spinal cord injury occurred. Thirteen cases with mild spinal cord injury recovered at 1 month after operation.

Conclusion. Anterior cervical surgery of decompression, reduction, stabilization, and fusion monitored by spinal cord evoked potential is an effective and safe method for treatment of subaxial cervical facet dislocation without or with mild spinal cord injury.

Level of Evidence: 4

Seventeen subaxial cervical facet dislocation cases were treated by anterior cervical surgery of decompression, reduction, stabilization, and fusion (ACDF) monitored by spinal cord evoked potential (SCEP). All operations were completed successfully and no redislocation or spinal cord injury occurred. ACDF monitored by SCEP is an effective and safe method for treatment of subaxial cervical facet dislocation with no or mild spinal cord injury.

*Department of Orthopedic Surgery, Qilu Hospital, Shandong University, Jinan, P.R. China; and

Department of Spine Surgery, Yantaishan Hospital, Yantai, P.R. China.

Address correspondence and reprint requests to Yanping Zheng, MD, Department of Orthopedic Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, 250012, P.R. China, E-mail: jody692@126.com

Acknowledgment date: May 14, 2013. First revision date: August 9, 2013. Second revision date: September 7, 2013. Acceptance date: September 16, 2013.

The device(s)/drug(s) is/are FDA-approved or approved by corresponding national agency for this indication.

No funds were received in support of this work.

No relevant financial activities outside the submitted work.

© 2014 by Lippincott Williams & Wilkins