Surgical Treatment Of Fracture-dislocation For The Cervicothoracic Junction With Bilateral Facet Joint Dislocation

Objective To evaluated the surgical strategy of posterior-anterior approach and anterior fixation in treatment of lower cervical spine fracture-dislocation with bilateral facet joints dislocation.Methods Retrospectively studied37lower cervical spine fracture with bilateral joints dislocation cases between March2004and May2012,21males and16females with an average age of42years (19-58y). DFS3(flexion-distraction stage3) were24cases and DFS4(flexion-distraction stage4)13cases. All the cases were taken X-ray, CT and MRI examinations before operations, and had been operated by posterior-anterior approach and anterior fixation. The American Acute Spinal Cord Injury Study (NASCIS) and international Medical Society of Paraplegia (IMSOP) standard were applied to definite the segment of cervical cord injury. The Frankel grading was used for evaluation the spinal cord function recovery rate. The X-ray and CT were taken monthly for observation of the reduction and the fusion of the bone grafts till the bone fusion.Results All cases were successfully operated, the operative time was4.5±0.5h, and the mean amount of blood loss was360ml(200～500ml). All the incision healed by first intension. Two cases with hoarseness after surgery were recovered within two months.2segments fixation was in23cases,3segments fixation was in13cases,4segments fixation was in1case. The mean follow up duration was32months (16～45months). Postoperative X-ray and CT showed that fusion was found in all patients between4and8months after the operation, and no loosening, broken of implant. Spinal cord function did not aggravate, sensory recovery7～20segments (average12.7). The Frankel grade was improved obviously and the average of1grade was increased.Conclusion Posterior-anterior approach for decompression, anterior fusion, and titanium plate anterior internal fixation are effective methods in the treatment of fracture-dislocation of the cervicothoracic junction with bilateral facet joint dislocation, and are helpful in retaining spinal cord function.