Analysis Of The Treatment Of Old Lower Cervical Facet Joint Injury(36Cases Report)

Objective: To explore the treatment of old lower cervical facet jointfracture and dislocationMethods: We conducted a retrospective review of36patients with oldlower cervical facet joint injury; the cases were obtained between January2010and January2014at our institute. The male-to-female ratio in thisgroup was29:7, and the mean age of the patients was36.4years (age range,26–69years). The mean time from injury to clinic was40.6days (range,23days-4months). According to the classification of lateral mass fractureprovided by Kotani, there were19cases of Separation type,4cases ofComminution type,10cases of Split type and3cases of Traumaticspondylolysis. The degree of damage and postoperative recovery wereevaluated by Frankel Grade and Clinical Symptom Score of the JapaneseOrthopaedic Association (JOA scale).Results: All patients were performed surgical treatment.7patientsunderwent posterior pedicle screw rod fixation,25patients underwentanterior cervical discectomy and fusion and4cases used theposterior-anterior-posterior approach. The follow-up period was13.9months on average (range6months to2years). Postoperatively the Frankelscore improved1level of18cases,2levels of17cases, and1caseimproved3levels. The JOA score improvement rate was75.3%on average(range57.1%-92.3%). With the follow up of6months, bone unions wereachieved in all the cases and no screws loosening, pulling out or breakingoccurred.Conclusion: The old lower cervical facet joint injury was complex and involved the bone and soft tissue badly. Clinical surgeon should evaluatethe perfect imaging examination in order to avoid misdiagnosis. Thepurpose of surgery was to remove spinal compression, fixation and restorecervical alignment. The consequence of posterior pedicle screw rodfixation for Separation type was satisfied. While the strategy for the otherstypes should consider the situation of compression.