Hospital Do Servidor Público Estadual de São Paulo, São Paulo, Brazil.
Division of Neurosurgery, University Hospital Lauro Wanderley/UFPB, João Pessoa, Paraíba, Brazil.
Neurosurg Rev. 2022 Aug;45(4):2659-2669. doi: 10.1007/s10143-022-01808-1. Epub 2022 May 21.
Adult cervical spine traumatic facet joint dislocations occur when excessive traumatic forces displace the vertebrae's facets, leading to loss of joint congruence. Reduction requires either cranial traction or open surgical procedures. This study aims to appraise the effects of different surgical techniques in the treatment of subaxial cervical spine acute traumatic facet blocks in adults. This study was based on a systematic literature review and meta-analysis, registered in Prospero (CRD42021279249). The PICO question was composed of adults with acute cervical spine traumatic facet dislocations submitted to anterior or posterior surgical approaches, associated or not with cranial traction for reduction. Each surgical technique was compared to the other. The primary clinical outcomes included neurological improvement or worsening and surgical success/failure rates. The anterior approach without cranial traction was efficient in reducing facet displacements. Skull traction was an efficient and immediate method to achieve spine dislocation reductions. Differences were not present among techniques regarding neurological improvement. There were no surgical failures in patients operated on via the posterior approach. The need to decompress and stabilize the cervical spine can be achieved by anterior or posterior surgical approaches, and there is no clear answer as to which initial approach is superior to the other.
成人颈椎创伤性关节突脱位是由于过度的创伤力使椎体关节突移位，导致关节失稳。复位需要颅牵引或开放手术。本研究旨在评估不同手术技术治疗成人下颈椎急性创伤性关节突块的效果。本研究基于系统文献回顾和荟萃分析，在 Prospero（CRD42021279249）中注册。PICO 问题由接受前路或后路手术治疗、伴或不伴颅牵引复位的急性颈椎创伤性关节突脱位的成年人组成。每种手术技术都与其他技术进行了比较。主要临床结局包括神经改善或恶化以及手术成功率/失败率。前路无颅牵引复位有效。颅骨牵引是一种有效、即时的脊柱脱位复位方法。不同技术之间在神经改善方面没有差异。后路手术患者均无手术失败。前路或后路手术均可达到颈椎减压和稳定的目的，目前尚不清楚哪种初始方法优于另一种方法。
