Prospective Clinical Studies Of Treatment For Subaxial Cervical Dislocations

PART Ⅰ Surgical Treatment for Subaxial Cervical Dislocationswith Incomplete or without Neurological DeficitObjective:This study aimed to treat patients with subaxial cervical facet dislocations with incomplete or without neurological deficit by a prospectively designed surgical protocol and observe the short-term clinical outcomes.Methods: Fifty-two consecutive subaxial cervical dislocation patients with incomplete or without neurological deficit were enrolled in the prospectively designed surgical protocol.The surgical strategy was determined based on whether or not the patients were simultaneously combined with traumatic disc herniation(TDH)and whether or not the initial anterior closed reduction was successful.The followed three strategies: single anterior approach,posterior-anterior approach and anterior-posterior-anterior approach were conducted to these patients.Postoperative radiographs were used to assess the reduction and fusion,and kyphosis and lordosis of cervical spines were calculated.The neck pain was assessed by visual analog scale(VAS).Body function and neurologic status was evaluated according to the Neck Disability Index(NDI)and classification of American Spinal Injury Association(ASIA).Clinical and radiologic outcomes were compared before and after the surgery and during the follow-up.Results: All the 52 patients successfully finished the surgeries.Seventeen patients with non-TDH and 5 patients with TDH were successfully treated by a single anterior approach,the other 22 non-TDH patients by a posterior-anterior(P-A)approach,and another eight TDH patients by an anterior-posterior-anterior(A-P-A)approach.No neurologic deterioration or other severe adverse events occurred postoperatively.The mean blood loss for single anterior,P-A,and A-P-A approaches was 78±30 m L,142±53 mL,and 189±44 m L,respectively.The mean total operation time was 66±19 minutes,112±44 minutes,and 136±37 minutes,respectively,and the mean hospital stay was 7.1±2.3 days,11.2±4.1 days,and 12.7±4.6 days,respectively.The kyphosis angle of the dislocated levels was well restored after surgery.The visual analog scale and neck disability index were significantly relieved as well(P < 0.05).The average follow-up period was 23 months.The neurologic status was obviously improved,and bony fusion was obtained in all patients within one-year follow-up.Conclusion: Our prospectively designed surgical strategy is effective for the treatment of patients with subaxial cervical dislocation with incomplete or without neurological deficit.This type of cervical dislocation could be treated by an anterior approach or a combined approach with favorable short-term clinical effects.PART Ⅱ A Prospective Study of the Surgical Management of theOld Lower Cervical DislocationsObjective: To evaluate the role of the canal and vertebrae sagittal diameter(C/V)ratio in the treatment of old dislocations of the lower cervical spine and the clinical effects of surgical management.Methods: Fourteen consecutive patients with old dislocations of the lower cervical spine were enrolled in this series.The preoperative C/V value was calculated based on the measurement on the neutral sagittal CT at the most narrow place of the dislocated segments.The surgical management was decided according to the C/V value.Closed reduction was attempted patients with moderate stenosis(C/V> 0.5),and the patients of severe stenosis(C/V≤0.5)were treated with a primary combined anterior and posterior operation.Patient radiographic information,pain,neurological function were assessed and recorded before and after surgery.Results: All the 14 patients did the surguries successfully.There were nine patients with moderate stenosis and 5 patients with severe stenosis.Nine patients with moderate stenosis attempted closed reduction,and 3 of them were succeeded and followed by anterior cervical discectomy and fusion(ACDF).Six of nine patients with moderate stenosis that failed in closed reduction and 5 patients of severe stenosis were performed circumferential release,posterior reduction and fixation,and followed by anterior fusion.No severe complications were found perioperatively.The average operative time was 138 ± 43 minutes.The average blood loss was 239 ± 140 m L.The mean hospital stay was 13.1 ± 4.6 days.The postoperative C/V value was significantly increased and the neck pain was significantly relieved(P<0.05).The neurological status improved at least one grade in all 13 neurologically impaired cases except for two that had complete spinal cord injuries.Bony fusion was obtained in all patients at 1-year follow up.Conclusion: The C/V value plays an important role in determining surgical solutions for old lower cervical dislocations with locked facets.Favorable clinical outcomes can be achieved using closed reduction and surgical procedures with anterior or anterior plus posterior approaches.