Yaffe Noah M, Labak Collin M, Kumar Pranav, Herring Eric, Donnelly Dustin J, Smith Gabriel
Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, USA.
Cureus. 2024 Sep 8;16(9):e68955. doi: 10.7759/cureus.68955. eCollection 2024 Sep.
Background Cervical facet dislocation is a serious injury that can result in permanent neurologic damage. Current guidelines recommend immediate closed reduction of cervical dislocations, though the efficacy of this practice remains a debate. This study aims to evaluate whether immediate open reduction and fixation of cervical dislocations offer equal or better outcomes for patients and limit the need for follow-up operations. Methods This is a retrospective study including patients who presented to the emergency department of a single institution from 2008 to 2023 with cervical facet dislocation. Patients were divided into groups based on initial treatment: either open or closed reduction. Time to surgery was calculated as the time between arrival to the ED and incision time in the OR. Primary outcomes were improvement in motor and sensory deficits at six-week post-operative follow-up. Results There were 31 patients who met the inclusion criteria. Time to treatment did not differ significantly between the open versus closed reduction groups. There were no differences between groups in improvement in motor function, sensory function, or pain at the six-week follow-up. All patients treated with initial closed reduction ultimately required surgical stabilization. Conclusions Open reduction as a first-line treatment did not increase the time to treatment for patients with cervical facet dislocations. Patients had equivalent functional outcomes in both treatment groups. The findings suggest that current practice guidelines may delay definitive treatment without improving patient safety or outcomes.
背景 颈椎小关节脱位是一种严重损伤，可导致永久性神经损伤。目前的指南建议立即对颈椎脱位进行闭合复位，尽管这种做法的疗效仍存在争议。本研究旨在评估颈椎脱位的立即切开复位和内固定是否能为患者带来同等或更好的结果，并减少后续手术的需求。方法 这是一项回顾性研究，纳入了2008年至2023年在单一机构急诊科就诊的颈椎小关节脱位患者。根据初始治疗方法将患者分为两组：切开复位或闭合复位。手术时间计算为从到达急诊科到手术室切开的时间。主要结局是术后六周随访时运动和感觉功能障碍的改善情况。结果 有31例患者符合纳入标准。切开复位组与闭合复位组的治疗时间无显著差异。在六周随访时，两组在运动功能、感觉功能或疼痛改善方面无差异。所有初始接受闭合复位治疗的患者最终都需要手术稳定治疗。结论 切开复位作为一线治疗方法并未增加颈椎脱位患者的治疗时间。两个治疗组患者的功能结局相当。研究结果表明，当前的实践指南可能会延迟确定性治疗，而不会提高患者安全性或改善结局。
