Comparison of a novel anterior-only approach and the conventional posterior–anterior approach for cervical facet dislocation: a retrospective study

Liu, Ke

doi:10.1007/s00586-019-06073-3

Cited by 15 publications

(7 citation statements)

References 38 publications

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“…Overall, our study did not find any statistically significant difference between European and American surgeons regarding definitive surgical management. The observation that most respondents selected ACDF when pursuing operative management of a cervical facet dislocation injury was expected, given recent and well-documented reports noting the viability of anterior-only approaches [4,13,24].…”

Section: Regional Variationsmentioning

confidence: 97%

Regional and experiential differences in surgeon preference for the treatment of cervical facet injuries: a case study survey with the AO Spine Cervical Classification Validation Group

et al. 2020

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Purpose The management of cervical facet dislocation injuries remains controversial. The main purpose of this investigation was to identify whether a surgeon's geographic location or years in practice influences their preferred management of traumatic cervical facet dislocation injuries. Methods A survey was sent to 272 AO Spine members across all geographic regions and with a variety of practice experience. The survey included clinical case scenarios of cervical facet dislocation injuries and asked responders to select preferences among various diagnostic and management options. Results A total of 189 complete responses were received. Over 50% of responding surgeons in each region elected to initiate management of cervical facet dislocation injuries with an MRI, with 6 case exceptions. Overall, there was considerable agreement between American and European responders regarding management of these injuries, with only 3 cases exhibiting a significant difference. Additionally, results also exhibited considerable management agreement between those with ≤ 10 and > 10 years of practice experience, with only 2 case exceptions noted. Conclusion More than half of responders, regardless of geographical location or practice experience, identified MRI as a screening imaging modality when managing cervical facet dislocation injuries, regardless of the status of the spinal cord and prior to any additional intervention. Additionally, a majority of surgeons would elect an anterior approach for the surgical management of these injuries. The study found overall agreement in management preferences of cervical facet dislocation injuries around the globe.

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Section: Regional Variationsmentioning

confidence: 97%

Regional and experiential differences in surgeon preference for the treatment of cervical facet injuries: a case study survey with the AO Spine Cervical Classification Validation Group

et al. 2020

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“…Kanna et al [14] in their study of 39 patients who were operated by the anterior approach, 22 patients with incomplete deficit showed recovery. Liu et al [25] in their study showed that 36.5% of their patients had a neurological recovery of atleast one grade. Reindl et al [20] in their study had a neurological recovery by one grade in many patients with one patient showing neurological worsening.…”

Section: Discussionmentioning

confidence: 93%

“…Lambiris et al [7] in their study showed a mean fusion rate of 90.5% in the anterior group and 82.6% in the posterior group. Liu et al [25] had a fusion rate of 100% in those operated by anterior approach.…”

Section: Discussionmentioning

confidence: 99%

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Is only anterior stabilization enough in three-column injury of subaxial cervical spine? – A long-term retrospective analysis of 78 patients

et al. 2021

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Study Design: This was a retrospective study. Purpose: The purpose was to retrospectively evaluate long-term outcome of anterior stabilization in three-column injury of the subaxial cervical spine. Overview of Literature: Literature shows varied results regarding the approach to be chosen. Most studies prefer a combined approach since biomechanically forms more stable construct. The isolated posterior approach is preferred by many as it is easy to reduce and fix three-column injuries. There are very few studies which show the isolated anterior approach to be better than the other two. Materials and Methods: Seventy-eight patients of three-column injury operated by anterior approach with follow-up of atleast 2 years were included and retrospectively analyzed. Clinical data included age, sex, time to surgery, methods of reduction, postoperative mobilization, and neurological evaluation using the ASIA scale. Radiological data included pre- and postreduction X-ray, computed tomography, and magnetic resonance imaging (MRI). X-rays taken post-operatively at 1,3, 6 months, 1yr and 2yrs. Variables like fracture type (AO Classification), overall alignment, localized kyphosis, time for fusion and grade of fusion mass were noted. Results: Of 78 patients, 61 had bifacetal dislocation and 17 unifacetal. The most common site was C5-6, followed by C3-4 and C6-7. The mean patient age was 35.98 years with 60 males and 18 females. The mean time to surgery was 4.4 days. Forty dislocations were reduced by closed method and 38 by open anterior approach. Fifty-six percent of patients had traumatic disc injury on MRI. All are managed by single-level anterior cervical discectomy and fusion with iliac crest autograft for fusion. The mean preoperative lordosis: 4.44° (range −13.4° to 25°) and mean postoperative lordosis: 28.57° ( P < 0.0001) mean loss of alignment: 2.59° by 2 years, 100% fusion with mean time – 22.82 weeks, neurological recovery in 34.6% with atleast one grade improvement in ASIA scale. No neurological worsening or need for revision surgery was observed. Conclusion: The goal of surgery in cervical injury is bony stabilization and fusion using a least morbid approach and one with good long-term outcome. Above study concludes that only anterior stabilization after reduction of three-column injury would suffice with good long-term outcome, thereby obviating need for global fusion.

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“…Anterior-only surgery has less blood loss and a shorter operative time and avoids prone turning of the patient intraoperatively, something that poses a potential risk of losing reduc-tion [7]. Facet reduction by the anterior approach can be achieved via intraoperative manipulation with a distraction technique [17] or, if required, by a facetectomy [18]. Moreover, the anterior-only approach offers direct decompression [19][20][21][22], by removing the offending agent and reducing the number of fused segments or the large surface area (i.e., the interbody area) to be fused, and has a lower infection rate [23].…”

Section: Discussionmentioning

confidence: 99%

Is Anterior-Only Fixation Adequate for Three-Column Injuries of the Cervical Spine?

et al. 2021

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To analyze the clinical and functional outcomes of patients who have undergone anterior cervical discectomy/corpectomy and fusion (ACDF/ACCF) for a three-column cervical spine injury (CSI). Overview of Literature: The treatment of choice for a three-column CSI is an area of contention; however, combined anterior and posterior fixation is the preferred method explored in the literature. Studies have shown the superior biomechanical stability of posterior fixation over that of anterior fixation, but anterior-only approach in CSI has been proving its efficacy in recent times by providing reasonable stability with the maximum achievable decompression and fusion. Methods: Twenty-one patients undergoing ACDF/ACCF with a bone graft/metallic cage treatment for cervical injuries involving all three columns from January 2016 to July 2018 were included in the study. All of the patients were followed up monthly for the first 3 months and then every 6 months, until their last follow-up visit. Results: Nineteen patients had AO type C injuries and were managed with ACDF, and two patients with AO type B injuries were managed with ACCF. Fifteen had a complete spinal cord injury, while six had an incomplete spinal cord injury (American Spinal Injury Association B, C, and D). The mean segmental kyphosis at presentation of 12.2°±4.4° improved in the postoperative period to-7.2°±2.5°. At their final follow-up, all the patients showed clinical improvements when assessed by the Visual Analog Scale (6.8-1.8), Oswestry Disability Index score (59.7-34.9), and Spinal Cord Independence Measure score (24.8-36.4). One patient in the ACDF group needed a secondary posterior fixation because of instability. Conclusions: An anterior approach to the cervical spine in cervical fracture dislocations is an effective treatment showing an optimal recovery rate in terms of patient-reported outcomes and structural stability, with the added advantages of less blood loss and the fact that the technique requires less instrumentation.

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Comparison of a novel anterior-only approach and the conventional posterior–anterior approach for cervical facet dislocation: a retrospective study

Cited by 15 publications

References 38 publications

Regional and experiential differences in surgeon preference for the treatment of cervical facet injuries: a case study survey with the AO Spine Cervical Classification Validation Group

Regional and experiential differences in surgeon preference for the treatment of cervical facet injuries: a case study survey with the AO Spine Cervical Classification Validation Group

Is only anterior stabilization enough in three-column injury of subaxial cervical spine? – A long-term retrospective analysis of 78 patients

Is Anterior-Only Fixation Adequate for Three-Column Injuries of the Cervical Spine?

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