Neglected bilateral facet dislocation of the cervical spine with intact neurology: Reduction technique

Jain, Mantu; Khuntia, Susanta; Rao, Bhaskar P

doi:10.4103/ajns.ajns_27_20

Cited by 5 publications

(10 citation statements)

References 12 publications

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“…Jain et al in 2020 presented a case of a 26-year-old patient with bilateral dislocation who was successfully treated with PA approach. 10 Shimada et al reported the case of bilateral dislocation which was managed successfully via PA approach as well: Posterior reduction and ACDF without preoperative reduction. 12 Srivastava et al performed closed reduction via skeletal traction in 50% (n = 3) of the patients for 3 weeks beginning with 3 kg till 8-10 kg.…”

Section: Discussionmentioning

confidence: 99%

“…Jain et al. in 2020 presented a case of a 26‐year‐old patient with bilateral dislocation who was successfully treated with PA approach 10 . Shimada et al.…”

Section: Discussionmentioning

confidence: 99%

“…These injuries often lead to neurological deficits, chronic pain, and cervical deformity 5,6 . There is no clear approach for treatment of neglected subaxial fracture‐dislocation in guidelines, 7,8 but a few literatures have suggested algorithms to obtain maximum alignment and resolve neurological symptoms 2,7,9,10 . Several surgical strategies such as single anterior, 6 single posterior, 11 posterior–anterior, 12–15 posterior–anterior–posterior, 7,16 and anterior–posterior–anterior–posterior 7 approaches have been reported but more studies are needed to conclude a definite protocol.…”

Section: Introductionmentioning

confidence: 99%

“…5,6 There is no clear approach for treatment of neglected subaxial fracture-dislocation in guidelines, 7,8 but a few literatures have suggested algorithms to obtain maximum alignment and resolve neurological symptoms. 2,7,9,10 Several surgical strategies such as single anterior, 6 single posterior, 11 posterior-anterior, [12][13][14][15] posterior-anteriorposterior, 7,16 and anterior-posterior-anterior-posterior 7 approaches have been reported but more studies are needed to conclude a definite protocol. We report our experience of surgical strategies of two patients with neglected subaxial cervical spine fracture-dislocation that came to our center with subsequent follow-ups.…”

Section: Introductionmentioning

confidence: 99%

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Risk factors and surgical approaches in neglected subaxial cervical spine fractures‐dislocations: Experiences with two cases and literature review

Pour‐Rashidi,

Pahwa,

Khanmirzaie

et al. 2024

Clinical Case Reports

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Key Clinical MessageThis case report describes our experience of surgical strategies of two patients with neglected subaxial cervical spine fracture‐dislocation that came to our center with subsequent follow‐ups. Subaxial cervical spine fracture‐dislocation must be immediately diagnosed and treated. However, it can be neglected in some cases, especially in developing health care systems and patients with low socioeconomic status. We reported two neglected subaxial cervical fracture‐dislocation with a mean age of 54 years old who presented with axial cervical pain, and decreased muscle forces. In one out of two, cervical closed traction was applied, then unsuccessful result led to circumferential decompression and fixation via anterior–posterior (AP) approach. Accordingly, we used AP approach without applying closed reduction in another patient successfully. Except one of our cases who died after 2 weeks of surgery due to aspiration pneumonia, other one found complete improvement at the end of 6‐month follow‐up. Our study emphasizes the importance of AP approach in patients with irreducible joint dislocations. The approach can minimize the surgical risks and increase the cost–benefit as compared to three or more staged approaches. Our approach is less intensive than some other AP approaches while is a safe and efficacious procedure since the posterior reduction is not performed before discectomy and decompression.

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Section: Discussionmentioning

confidence: 99%

“…Jain et al. in 2020 presented a case of a 26‐year‐old patient with bilateral dislocation who was successfully treated with PA approach 10 . Shimada et al.…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Risk factors and surgical approaches in neglected subaxial cervical spine fractures‐dislocations: Experiences with two cases and literature review

Pour‐Rashidi,

Pahwa,

Khanmirzaie

et al. 2024

Clinical Case Reports

View full text Add to dashboard Cite

show abstract

“…Although the choice of approach and use of initial closed reduction are debatable, most of the authors have stressed the need for both anterior and posterior approaches for alignment and stabilization. 18 The extensive combined approach increases the duration of the surgery, blood loss, length of hospital stay, and risk of neurological injury. A high rate of dysphagia has been seen in the combined anterior and posterior approaches.…”

Section: Discussionmentioning

confidence: 99%

Neglected Cervical Facet Dislocation without Neurological Deficit: A Simple Solution to a Complex Problem—A Case Series and Review

Kumar,

Rai,

Dhatt

2024

Indian Journal of Neurotrauma

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Cervical facet dislocation is a disastrous injury. Delayed presentation is not uncommon owing to various reasons in developing countries. Autofusion and a halt in progression are seen in spondylolysis and spondylolisthesis. Conservative treatment with close observation can be offered to the carefully selected patients with neglected cervical facet dislocations with intact neurology, as the injury is stable after autofusion. We registered eight male patients with cervical facet dislocation with delayed presentation for various reasons. Dynamic radiographs, computed tomography (CT) scan, and magnetic resonance imaging (MRI) were done to rule out any instability, cord compression, or bony fusion. Patients were followed up for 6 months clinically and radiologically. A total of eight patients presented with cervical facet dislocation, with a mean delay in presentation of 33 weeks (range: 14–54 weeks). Postinjury, all the patients were neurologically intact, with the only complaint of cervical pain at presentation. Dynamic radiographs did not show any instability. No cord compression or changes were noted on the MRI. Conservative management was advised for all eight patients. A subsequent follow-up CT scan demonstrated bony fusion at the dislocated facets in three of these patients. All the patients remained neurologically intact, with no further progression of the deformity. Surgical management is the mainstay of treatment for neglected facet dislocations. A combined approach has been advocated in most of the studies for proper reduction and alignment in these cases, which is quite extensive and has its own morbidity. A trial of conservative treatment can be offered to selected patients with intact neurology.

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Delayed presentation of lower cervical facet dislocations: What to learn from past reports?

Nkurikiyumukiza,

Buteera,

El-Sharkawi

2024

SICOT-J

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Delayed presentation of lower cervical facet dislocations is uncommon, and there is no standardized way to approach these neglected injuries. The literature on neglected lower cervical facet dislocations is limited to case reports and few retrospective studies. This justifies the need for a comprehensive review of this condition. Our purpose was to elaborate a review on the epidemiology, clinical and radiological presentation, and treatment techniques and approach to these neglected injuries. Middle-aged adults from 30 to 50 represent 73.8% of reported cases, and most of them are males (72.0%). The most affected level is C5–C6 (43.0%). While most delays are due to missed injuries (52.1%) and ineffective non-operative treatment (36.2%), the other reason for delay is negligence in seeking medical care (11.7%). Patients present with variable degrees of neurological deficit, persistent neck pain, and neck stiffness. Reported approaches and techniques to reduce and stabilize these injuries are highly variable and depend on the surgeon’s judgment, experience, and preference. Fibrotic tissues and bony fusion around the dislocated facet joint contribute to the reduction challenge, and 77.0% of closed reduction attempts fail. Anterior and posterior approaches to the cervical spine are used selectively or in combination for surgical release, reduction, and stabilization. Despite the lack of standardized treatment guidelines and different approaches, most of the authors reported improvement in pain, balance, and neurology post-surgery. Starting with the posterior surgical approach aims to achieve reduction compared to the anterior approach which largely aims at spinal decompression. Given the existing controversies, the need for quality prospective studies to determine the best treatment approach for lower cervical facet dislocations presenting with delay is evident.

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Neglected bilateral facet dislocation of the cervical spine with intact neurology: Reduction technique

Cited by 5 publications

References 12 publications

Risk factors and surgical approaches in neglected subaxial cervical spine fractures‐dislocations: Experiences with two cases and literature review

Risk factors and surgical approaches in neglected subaxial cervical spine fractures‐dislocations: Experiences with two cases and literature review

Neglected Cervical Facet Dislocation without Neurological Deficit: A Simple Solution to a Complex Problem—A Case Series and Review

Delayed presentation of lower cervical facet dislocations: What to learn from past reports?

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