Department of Neurological Surgery, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea; and.
Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
J Neurosurg Spine. 2015 Jul;23(1):35-41. doi: 10.3171/2014.11.SPINE14805. Epub 2015 Apr 24.
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.
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.
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.
Open reduction followed by pedicle screw fixation or posterolateral removal of herniated disc fragments is a good treatment option for cervical facet dislocations.
颈椎小关节脱位的最佳治疗方法存在争议，但被普遍接受的治疗流程是先进行闭合复位，如果复位成功且存在创伤性椎间盘突出，则根据复位的结果决定下一步治疗方案。本研究旨在展示后路切开复位、椎弓根螺钉固定并切除椎间盘碎片治疗下位颈椎小关节脱位的疗效。
2012 年 3 月至 2013 年 9 月，共纳入 21 例颈椎小关节脱位患者。病变节段为：C3-4 节段 4 例，C4-5 节段 2 例，C5-6 节段 5 例，C6-7 节段 10 例。7 例患者合并创伤性椎间盘突出。未行闭合复位，直接行后路颈椎切开复位术。复位后行椎弓根螺钉固定。对于合并创伤性椎间盘突出的患者，经后路行椎间盘切除术，术后 MRI 检查确定减压是否成功。采用美国脊柱损伤协会（ASIA）分级系统评估临床疗效，通过比较术前、术后 CT 扫描测量的半脱位程度和节段前凸角评估影像学疗效。
所有患者神经功能均得到改善。节段角度从术前的 7.3°±8.68°改善至术后的-5.9°±4.85°。半脱位程度从术前的 23.4%±16.52%改善至术后的 2.6%±7.19%。7 例椎间盘突出患者的 MRI 显示椎间盘碎片被成功切除。
后路切开复位、椎弓根螺钉固定或后路切除椎间盘碎片是治疗颈椎小关节脱位的有效方法。
