Anissipour Alireza K, Agel Julie, Baron Matthew, Magnusson Erik, Bellabarba Carlo, Bransford Richard J
Harborview Medical Center, Seattle, WA, USA.
Global Spine J. 2017 Apr;7(2):110-115. doi: 10.1177/2192568217694002. Epub 2017 Apr 6.
Retrospective radiographic and chart review.
To define the rate and associated risk factors of treatment failure of anterior cervical fusion for treatment of cervical facet dislocations.
Between 2004 and 2014, a retrospective review at a single level 1 trauma center identified 38 patients with unilateral or bilateral dislocated facet(s) treated with anterior cervical discectomy and fusion (ACDF). Two patients were eliminated due to less than 30-day follow-up. Demographic data, initial neurological exams, surgical data, radiographic findings, and follow-up records were reviewed.
Of the 36 patients with facet dislocations treated with ACDF using a fixed locking plate, 16 were unilateral and 20 were bilateral. The mean age was 35 years (range 13-58). Mean follow-up was 323 days (range 30-1998). There were 3 treatment failures (8%). Three of 7 (43%) endplate fractures failed ( < .01), and 1/28 (4%) facet fractures failed ( = .13). The mean time to failure was 4 weeks (1-7 weeks). One treatment failure had a facet fracture, and all 3 failures had an associated endplate fracture.
Treatment failure occurred in 3 out of 36 (8%) patients with facet fracture dislocations treated with anterior cervical discectomy, fusion, and plating. Rates of failure are lower than has been previously reported. Endplate fractures of the inferior level in jumped facets appears to be a major risk factor of biomechanical failure. However, a facet fracture may not be a risk factor for failure. In the absence of an endplate fracture, ACDF is a reasonable treatment option in patients with single-level cervical facet dislocation.
回顾性影像学及病历回顾。
明确颈椎小关节脱位前路颈椎融合术治疗失败的发生率及相关危险因素。
2004年至2014年期间，在一家一级创伤中心进行回顾性研究，确定38例单侧或双侧小关节脱位患者接受了颈椎前路椎间盘切除融合术（ACDF）。2例因随访时间不足30天被排除。对人口统计学数据、初始神经学检查、手术数据、影像学检查结果及随访记录进行回顾。
在36例采用固定锁定钢板行ACDF治疗小关节脱位的患者中，16例为单侧脱位，20例为双侧脱位。平均年龄35岁（范围13 - 58岁）。平均随访323天（范围30 - 1998天）。有3例治疗失败（8%）。7例终板骨折中有3例（43%）失败（P <.01），28例小关节骨折中有1例（4%）失败（P =.13）。失败的平均时间为4周（1 - 7周）。1例治疗失败伴有小关节骨折，所有3例失败均伴有终板骨折。
36例接受颈椎前路椎间盘切除、融合及钢板固定治疗小关节骨折脱位的患者中有3例（8%）治疗失败。失败率低于先前报道。跳跃小关节下方终板骨折似乎是生物力学失败的主要危险因素。然而，小关节骨折可能不是失败的危险因素。在无终板骨折的情况下，ACDF是单节段颈椎小关节脱位患者的合理治疗选择。
