Surgical treatment of traumatic cervical facet dislocation: anterior, posterior or combined approaches?

Abstract

Surgical treatment is well accepted for patients with traumatic cervical facet joint dislocations (CFD), but there is uncertainty over which approach is better: anterior, posterior or combined. We performed a systematic literature review to evaluate the indications for anterior and posterior approaches in the management of CFD. Anterior approaches can restore cervical lordosis, and cause less postoperative pain and less wound problems. Posterior approaches are useful for direct reduction of locked facet joints and provide stronger fixation from a biomechanical point of view. Combined approaches can be used in more complex cases. Although both anterior and posterior approaches can be used interchangeably, there are some patients who may benefit from one of them over the other, as discussed in this review. Surgeons who treat cervical spine trauma should be able to perform both procedures as well as combined approaches to adequately manage CFD and improve patients’ final outcomes.

Subaxial Cervical Spine Injury in the Elderly and Treatment-Related Mortality – Anterior or Posterior Approach

“…As a specific postoperative complication, dysphagia appears to develop more often after anterior than after posterior stabilisation [3,14,18,20]. This is consistent with the present results.…”

“…The procedures included in the present study were also performed essentially according to the recommendations of the Spine Section of the German Society for Orthopaedic and Trauma Surgery [1,2,12,22,30]. However, in the case of Bechterewʼs disease or highly unstable translational injuries, there are recommendations supporting an initially posterior spondylodesis, because in previous studies these cases have demonstrated a high degree of biomechanical stability [3,12,19,21]. In their systematic review, Dvorak et al [13] recommend in this respect treating compression and distraction injuries using anterior approaches, while managing translational injuries by posterior or combined approaches.…”

“…Furthermore, an anterior approach is often associated in the literature with less surgical trauma, a shorter hospital stay, less postoperative pain and fewer complications [1, 5, 14 -19]. An increased rate of wound infection also appears to occur after posterior spondylodesis [3,14,16].…”

“…Injury to the subaxial cervical spine is particularly common in cervical spine trauma of any type [1]. More than one half of these injuries involve the segments C5-C7 [2,3].…”

“…Anterior procedures appear to involve, amongst other things, less surgical trauma but are more commonly associated with postoperative dysphagia [1, 5, 14 -20]. Posterior approaches usually ensure a high degree of biomechanical stability but bring with them a higher rate of postoperative wound infections [3,12,14,19,21]. To what extent these two surgical approaches determine the overall outcome is the subject of numerous discussions.…”