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Journals / Bağcılar Tıp Bülteni / 2020 / Cilt: 5 - Sayı: 3

Facet Dislocation Fractures of Subaxial Cervical Spine: A Treatment Algorithm for Surgical Approach Decision

Subaksiyel Servikal Omurganın Faset Dislokasyon Fraktürleri: Cerrahi Yaklaşım Kararı için Tedavi Algoritması

Barış ÖZÖNER
Levent AYDIN
Songül Meltem CAN
Ahmet Murat MÜSLÜMAN
Adem YILMAZ
Pages
123–132
Publication Date
2022-10-12
DOI
—
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⚡ TL;DR(Too Long; Didn't Read)

Conclusion: The treatment algorithm for subaxial facet dislocations based on DFS and TDH presence provided satisfactory results.Keywords: Allen and Ferguson classification, decision-making, facet dislocation fracture, subaxial cervical spine, subaxial injury classification and Severity scale, traumatic disc herniation

📌 3 Key Takeaways

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Objective & Hypothesis:Objective: To perform an analysis of the surgical approach choice in subaxial cervical spine (SCS) facet dislocations.Method: The inclusion criteria were as follows: radiologically confirmed traumatic SCS facet dislocation, 18-70 years of age, stable medical condition, and isolated cervical trauma.
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Key Findings & Data:Anterior stabilization was sufficient in AFC distractive flexion stage (DFS) 2 fractures while combined stabilization was performed in DFS 3 and 4 fractures.
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Conclusion & Impact:Conclusion: The treatment algorithm for subaxial facet dislocations based on DFS and TDH presence provided satisfactory results.Keywords: Allen and Ferguson classification, decision-making, facet dislocation fracture, subaxial cervical spine, subaxial injury classification and Severity scale, traumatic disc herniation
🔬Design:Research Article
📍Scope:Comprehensive Sample
⚙️Variables:Domain Parameters

Abstract

Objective: To perform an analysis of the surgical approach choice in subaxial cervical spine (SCS) facet dislocations.Method: The inclusion criteria were as follows: radiologically confirmed traumatic SCS facet dislocation, 18-70 years of age, stable medical condition, and isolated cervical trauma. The management scheme was based on the presence of traumatic disc herniation (TDH) and the grade of dislocation according to the Allen and Ferguson classification (AFC). In the absence of TDH, the reduction was attempted via traction under general anesthesia before surgery. In the presence of TDH, the reduction wasattemptedafteranteriordiscectomy.Posterioropenreductionwas performed in case of an unsuccessful reduction attempt. Anterior stabilization was sufficient in AFC distractive flexion stage (DFS) 2 fractures while combined stabilization was performed in DFS 3 and 4 fractures. Results: Thirty-two patients were included in the study. TDH was detected in 14 patients. The number of patients with DFS 2, 3, and 4 fractures was 6, 18, and 8, respectively. Posterior open reduction was needed in 9 patients. Anterior stabilization was performed in 6 patients (3 with TDH, 3 without TDH) and combined stabilization was performed in 26 patients (11 with TDH, 15 without TDH) via 6 anterior, 7 anterior-posterior, 15 posterior-anterior, and 4 anterior-posterior-anterior approaches. Satisfactory follow-up results were achieved in radiological and neurological evaluations, and neck pain scores. Conclusion: The treatment algorithm for subaxial facet dislocations based on DFS and TDH presence provided satisfactory results.Keywords: Allen and Ferguson classification, decision-making, facet dislocation fracture, subaxial cervical spine, subaxial injury classification and Severity scale, traumatic disc herniation

Özet

Amaç: Bu çalışmada subaksiyel servikal omurga (SSO) faset dislokasyon fraktürlerinde cerrahi yaklaşım seçimi algoritması geliştirilmesi amaçlanmıştır. Yöntem: Çalışmaya dahil edilme kriterleri şu şekildeydi: Radyolojik olarak gösterilmiş travmatik SSO faset dislokasyon fraktürü, 18-70 yaş, medikal olarak stabil durum ve izole servikal travma varlığı. Tedavi algoritması temel olarak, travmatik disk herniasyonu (TDH) varlığına ve Allen ve Ferguson sınıflamasına (AFS) göre dislokasyon derecesine göre düzenlenmekteydi. Radyolojik incelemelerde TDH saptanmazsa, cerrahi girişim öncesinde genel anestezi altında traksiyon ile redüksiyon denenmesi yapılmaktaydı. TDH varlığında ise traksiyon denemesi öncesinde anterior diskektomi yapılmaktaydı. Eğer traksiyon ile redüksiyon girişimi başarısız olursa, posterioraçıkredüksiyonyapılmaktaydı.AFS’sinegöredistraktivefleksiyon evre (DFE) 2 fraktürlerinde anterior stabilizasyon uygulanırken, DFE 3 ve 4 dislokasyonlarda kombine stabilizasyon yapılmaktaydı. Bulgular: Çalışmaya 32 hasta dahil edildi. On dört hastada radyolojik incelemelerde TDH saptandı. Altı hastada DFE 2, 18 hastada DFE 3 ve 8 hastada DFE 4 faset dislokasyon fraktürü mevcut idi. Posterior açık redüksiyon 9 hastada gerekli oldu. Altı hastaya (3 TDH’si olan, 3 TDH’si olmayan) anterior stabilizasyon ve 26 hastaya (11 TDH’si olan, 15 TDH’si olmayan) kombine stabilizasyon uygulandı. Altı anterior, 7 anterior-posterior, 15 posterior-anterior ve 4 anterior-posterior-anterior yaklaşım uygulandı.Radyolojik,nörolojikdeğerlendirmelerdeveboyunağrısıskorlarında tatmin edici sonuçlar elde edildi. Sonuç:DFEveTDHvarlığınagöreoluşturulansubaksiyelfasetdislokasyonları için cerrahi tedavi algoritması ile başarılı sonuçlar elde edilmiştir.

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Cite This Article

ÖZÖNER, B., AYDIN, L., CAN, S. M., MÜSLÜMAN, A. M., YILMAZ, A. (2022). Facet Dislocation Fractures of Subaxial Cervical Spine: A Treatment Algorithm for Surgical Approach Decision. Bağcılar Tıp Bülteni, Cilt: 5 - Sayı: 3, 123–132. https://ajindex.com/articles/458961

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