Doran S E, Papadopoulos S M, Ducker T B, Lillehei K O
Section of Neurosurgery, University of Michigan Medical Center, Ann Arbor.
J Neurosurg. 1993 Sep;79(3):341-5. doi: 10.3171/jns.1993.79.3.0341.
The coexistence of traumatic locked facets of the cervical spine and a herniated disc is not well described. The authors present a series of patients with traumatic locked facets who demonstrated a high incidence of associated disc herniation documented on magnetic resonance (MR) imaging. Thirteen patients with either unilateral (four cases) of bilateral (nine cases) locked facets of the cervical spine were analyzed retrospectively. Immediate closed reduction using traction and/or manipulation was attempted in the first nine cases treated and was successful in only three; however, the procedure was abandoned in three cases due to deterioration in the patient's clinical status. In the subsequent four patients, an MR image was obtained prior to attempts at closed reduction. All patients underwent MR imaging of the cervical spine. Of eight consecutive cases treated at the University of Michigan, frank disc herniation with fragmented disc in the canal was found in five while pathological disc bulging was found in the other three. All five cases contributed by other institutions had concurrent disc herniation. This series illustrates the importance of using MR imaging to document the presence of a herniated disc during the initial evaluation of a patient with traumatic locked facets of the cervical spine and prior to attempted reduction of the locked facets. Experience indicates that closed reduction of facet dislocation associated with disc rupture may result in increased spinal cord compression and neurological deficit. If a herniated disc is discovered, anterior discectomy and fusion would be favored as the initial therapy over attempts at closed reduction or operative posterior reduction.
颈椎创伤性小关节交锁与椎间盘突出并存的情况鲜有描述。作者报告了一系列创伤性小关节交锁患者，磁共振成像（MR）显示其合并椎间盘突出的发生率很高。对13例颈椎单侧（4例）或双侧（9例）小关节交锁患者进行了回顾性分析。在前9例接受治疗的患者中尝试了立即通过牵引和/或手法进行闭合复位，仅3例成功；然而，有3例因患者临床状况恶化而放弃该操作。在随后的4例患者中，在尝试闭合复位前进行了MR成像。所有患者均接受了颈椎MR成像检查。在密歇根大学治疗的连续8例患者中，5例发现椎管内有明显的椎间盘突出伴椎间盘碎片，另外3例发现病理性椎间盘膨出。其他机构提供的所有5例病例均合并椎间盘突出。该系列病例表明，在对颈椎创伤性小关节交锁患者进行初始评估时以及在尝试复位小关节之前，使用MR成像记录椎间盘突出情况的重要性。经验表明，与椎间盘破裂相关的小关节脱位闭合复位可能会导致脊髓压迫增加和神经功能缺损。如果发现椎间盘突出，与尝试闭合复位或手术后路复位相比，前路椎间盘切除融合术更适合作为初始治疗方法。
