Srivastava Abhishek, Soh Reuben Chee Cheong, Ee Gerard Wen Wei, Tan Seang Beng, Tow Benjamin Phak Boon
Spine Service, Department of Orthopaedic Surgery, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore.
Eur Spine J. 2014 Aug;23(8):1612-6. doi: 10.1007/s00586-014-3318-7. Epub 2014 May 7.
There is limited literature on the management of neglected healed (fused) bilateral cervical facet dislocation. The authors report a case of a middle aged male who developed a bilateral facet dislocation but only sought treatment 14 months post injury when he experienced pain and deformity in the cervical spine.
A 42-year-old male was pushed into a 1.2-m pool by accident and hit his head on the bottom. He immediately felt a sharp pain in his neck but was able to get out of the pool by himself and at the emergency department was found to have no neurological deficit. Standard trauma radiographs were performed and a grade 1 anterolisthesis of C4 on C5 was observed without any facet subluxation or dislocation. An emergent Magnetic Resonance Imaging (MRI) of the cervical spine confirmed X-ray results and in addition demonstrated injury to the posterior ligament complex and a broad-based posterior disc bulge. Computed Tomography (CT) scans revealed no facet dislocation or fractures. Unfortunately, the patient failed to come for his follow-up visits and at 14 months post injury, represented with pain and deformity with impairment of horizontal gaze. Computed tomography and MRI demonstrated a fused (bony) bilateral facet dislocation at C4/5. A cervical spine reconstruction consisting of a posterior-anterior-posterior approach was performed to address both the deformity and the pain. At 32-month follow-up, the patient remains well with no neurological symptoms, minimal neck pain and successful fusion.
Current literature does not offer a clear solution to the management of healed neglected bilateral cervical facet dislocation. The presence of circumferential bony fusion around the deformity necessitates a posterior and anterior release and subsequent stabilization to address this complex problem. We also wish to highlight the order of the reconstructive approach and the need to recognize instability of the cervical spine despite normal CT scans in order to prevent late deformity.
关于被忽视的愈合（融合）双侧颈椎小关节脱位的治疗，相关文献有限。作者报告了一例中年男性病例，该患者发生了双侧小关节脱位，但在受伤14个月后出现颈椎疼痛和畸形时才寻求治疗。
一名42岁男性意外被推入一个1.2米深的水池，头部撞到池底。他立即感到颈部剧痛，但能够自行从池中出来，在急诊科检查发现没有神经功能缺损。进行了标准的创伤X线检查，观察到C4椎体相对于C5椎体有I度前滑脱，没有任何小关节半脱位或脱位。颈椎紧急磁共振成像（MRI）证实了X线检查结果，此外还显示后韧带复合体损伤和广泛的椎间盘后凸。计算机断层扫描（CT）显示没有小关节脱位或骨折。不幸的是，患者未能前来复诊，在受伤14个月后，因疼痛、畸形和水平凝视障碍前来就诊。CT和MRI显示C4/5水平存在融合（骨性）双侧小关节脱位。采用前后联合入路进行颈椎重建，以解决畸形和疼痛问题。在32个月的随访中，患者情况良好，没有神经症状，颈部疼痛轻微，融合成功。
目前的文献对于已愈合的被忽视的双侧颈椎小关节脱位的治疗没有提供明确的解决方案。畸形周围存在环形骨融合需要进行前后松解并随后进行稳定化处理，以解决这个复杂问题。我们还希望强调重建方法的顺序以及尽管CT扫描正常但仍需认识到颈椎不稳定的必要性，以防止晚期畸形。
