Anterior Approach In Treatment Of Early Fracture-dislocation Of The Lower Cervical Spine With Facet Joint Dislocation

Background:In recent years, with the sharp rise in trauma patients, cervical spine injury also increased, accounting for 3% of trauma patients about cervical spine injury including nerve root damage and complete or incomplete spinal cord injury. Cervical flexion distraction type of fracture and dislocation of lower cervical spine injuries are common types, including flexion facet subluxation, the rear extension-type injury Complex, spinous process spacing widened; unilateral facet dislocation; bilateral facet dislocation, displacement anteroposterior diameter of up to 50% of vertebral body; bilateral facet dislocation, the shift of the anteroposterior diameter of vertebral body width. Flexion distraction-type injury, including the seriousness of the latter three types. Use more traditional methods halo skull traction or external fixation fracture and dislocation of lower cervical spine, but the skull halo traction and external fixation can not achieve the effective decompression of spinal cord compression, cervical sequence is restored, there are many cases could not resume normal sequence, has been not just applications. With advances in technology, nearly 20 years on the lower cervical spine fracture and dislocation of spinal cord injury recovery and understanding of the pathological understanding deepened, spinal fixation and internal fixation technology, spine surgeon with the lower cervical spine facet fracture dislocation twist who not only need to restore the cervical series, but also the full line of nerve decompression, internal fixation, reconstruction of cervical spine stability, provide space given to neurological recovery, is now widely accepted principle of treatment. For the lower cervical facet fracture dislocation with twist lock treatment of many, such as closed reduction and external fixation, has no application, preoperative anterior cervical fusion surgery after manipulative reduction, reduction and internal fixation posterior cervical fusion surgery , anterior reduction and internal fixation. For the lower cervical facet dislocation with fracture were treated with a twist anterior interbody fusion with plate fixation for reduction, so that cervical sequence recovery, reconstruction of spinal stability. Is both economical and practical method, which can be one direct line of anterior decompression, removal of lesions prominent discs, vertebral dislocation of the surrounding tissue release, and the use of force in both directions, so that normal cervical spine series, surgical trauma the time is short, less bleeding, reconstruction of spinal stability, providing neurological recovery opportunities. Reset an anterior interbody fusion with plate fixation is the ideal treatment for cervical flexion distraction type injury reduction, decompression, a method of fixation.Objective: Of pure anterior dislocation with fracture of the lower cervical spine in early facet twist the feasibility and clinical effects.Methods: From October 2008 to 2010 in June, early treatment of anterior dislocation with fracture of the lower cervical spine facet twist in 10 cases. 8 males and 2 females, aged from 20 to 53 years, mean 43.3 years old. After injury were completed within 6-72 hours of surgery, the average 24h±6h. Injuries due to traffic injuries in 7 cases, 1 case of injury fell to the ground height, weight injured in 1 case, 10 cases were distractive flexion type injury. 10 patients, according to Allen type: flexion distraction type (II degree) in 2 cases (III degree) in 4 cases (IV degree) in 4 cases. 10 cases with anterior plate fixation for the treatment of lower cervical fracture dislocation with early facet twist. United States National Acute Spinal Cord Injury Study Group (NASCIS) 1990 recommended diagnosis of spinal cord injury nerve, cervical spinal cord injury to determine the plane, ASIA grade to determine the recovery of the spinal cord, A 5 cases, B 4 cases, C 1 case . All patients underwent preoperative cervical spine X ray, CT and MRI. Fracture-dislocation segment is: C4, 5 vertebrae in 2 cases, C5, 6 vertebrae in 4 cases, C6, 7 vertebrae in 3 cases, C7T11 cases. 2 cases of unilateral facet twist, 4 cases of bilateral facet dislocation, degree of displacement up to 50% of the anteroposterior diameter of vertebral body, 4 cases of bilateral facet dislocation, the shift of the anteroposterior diameter of vertebral body width. All patients under general anesthesia anterolateral cervical anterior cervical discs removed, whether the end-plate special attention to peel, it broke into the spinal canal, full spinal decompression. Hand of the audience go further aided by the axis of skull traction cervical traction and flexion 20°-30°, the surgeon is back on the application of sub-periosteal stripping resist dislocation of the lower edge of vertebral body, under the unified command surgeon, while Shi Lili with two directions of the force, the vast majority of cervical can resume normal sequence. Small number of patients who can not be found again, the surgeon in the vertebral body resist upper body while the lower edge of lower vertebrae. 1,3,6,12 months after surgery were taken in the lateral cervical spine X-ray observations are reset and bone fusion.Result:10 patients underwent anterior cervical spine surgery. The operation time of about 40-60 minutes, blood loss was 30ml-100ml, incision healed. Reset time is about 30 seconds -2 minutes to return to normal cervical sequence. In this method, 8 patients a one-time reduction, 2 patients 2 times reduction, postoperative dislocation segment cross-section of the spinal canal encroachment maximum recovery of 89%, the largest correction of cervical kyphosis nearly 60°. Single-segment fixation in 6 cases, dislocation of the lower vertebral body corpectomy in 4 cases, 8 cases of autologous bone grafts, titanium mesh cage in 2 cases. Follow-up 6-24 months, all bone fusion, fixation in good position, no graft loss, subsidence, internal fixation without loosening, bending, breaking and other complications after spinal cord injury patients with no increase, immediately restored 2-4 sensory level, followed up for 6 months after the recovery of sensation was 3-10 (average 6.5) in a plane, muscle restored about an average of about 1±, spinal cord function improved one ASIA grade average.Conclusions: Anterior cervical approach alone can be treated early with lower cervical facet fracture and dislocation of twist. Has the following advantages: 1, cervical reset is done under the visible, avoiding violence and blindness. Avoid the inter-plate or end plate free of the spinal cord reperfusion. Reset simple, fast and effective. 2, without posterior surgery, or surgery to avoid a second operation in the process of turning over several times in spinal cord injury. 3, patient costs down, reduce damage and reduce the risk of surgery. Disadvantages: there is the same surgeon and his assistant with the risk of preoperative training should be strict in order to reach consensus.