New reduction technique for the treatment of unilateral locked facet joints of the lower cervical spine

Wang, Xinjia; Yao, Guanfeng; Chen, Yu‐Chun; Wei-dong, Wang; Zeng, Jun

doi:10.1007/s00132-017-3456-9

Cited by 7 publications

(4 citation statements)

References 30 publications

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“…Reinhold et al, 44 in their 117 patients' study, concluded that if closed reductions are performed within 4 hours of injury, the reduction achievement and neurological improvement are better. Wang et al, 45 in their retrospective analysis of 12 patients, reported no worsening while using manual counter-rotation technique. Early traction with Gardner and Wells tongs has achieved a reduction in 97% of patients analyzed retrospectively by Grant et al 46 Two patients (2.4%) failed to reduce, and 1 (1.3%) deteriorated in their analysis of 121 patients.…”

Section: Closed Reduction Techniquesmentioning

confidence: 97%

Subaxial Cervical Spine Injuries: WFNS Spine Committee Recommendations

et al. 2020

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Section: Closed Reduction Techniquesmentioning

confidence: 97%

Subaxial Cervical Spine Injuries: WFNS Spine Committee Recommendations

et al. 2020

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“…In the previous literature, the prevalence of success of reduction in patients with unilateral locked facet was between 14 and 36% 18 , 27 . Wang et al modified a reduction procedure with the halo-vest system through bracing of multiple flexion–extension activities, and all patients with unilateral locked facet in their study achieved successful closed reduction 28 . In the present study, closed reduction by skull traction was achieved in 27 (49.1%) of the 55 patients.…”

Section: Discussionmentioning

confidence: 99%

Classification of unilateral cervical locked facet with or without lateral mass-facet fractures and a retrospective observational study of 55 cases

Tang

Fan

Liao

et al. 2021

Sci Rep

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This study describes a morphology-based unilateral cervical facet interlocking classification in an attempt to clarify the injury mechanism, instability, neurological deficits, radiological features, and determine optimum management strategies for these injuries. A total of 55 patients with unilateral cervical locked facet (UCLF) involving C3 to C7 were identified between January 1, 2012 and December 1, 2019. The injuries were classified into three types, and they were further divided into six subtypes using three-dimensional computed tomography. The injury mechanism, clinical features, neurological deficits, and imaging characteristics were analyzed, and the appropriate treatment strategies for UCLF were discussed. UCLFs were divided into the following six subtypes: UCLF without lateral mass-facet fracture (type I) in nine cases, with superior articular process fracture (type II A) in 22, with inferior articular process fracture (type II B) in seven, both superior and inferior articular process fractures (type II C) in four, with lateral mass splitting fracture (type III A) in three, and with lateral mass comminution fractures (type III B) in ten. A total of 22 (40.0%) of the 55 patients presented with radiculopathy, and 23 patients (41.8%) had spinal cord injuries. The subtype analyses showed high rates of radiculopathy in types II A (68.2%) and II C (75.0%), as well as significant spinal cord injury in types I (77.8%) and III (61.5%). Destruction of the facet capsule was observed in all patients, but the injury of disc, ligamentous complex, and vertebra had a significant difference among the types or subtypes. The instability parameters of the axial rotation angle, segmental kyphosis, and sagittal displacement showed significant differences in various types of UCLF. Closed reduction by preoperative and intraoperative general anesthesia traction was achieved in 27 patients (49.1%), and successful rate of closed reduction in type I (22.2%) was significantly lower than that in type II (51.5%) and type III (61.5%). A total of 35 of 55 patients underwent a single anterior fixation and fusion, 10 patients were treated with posterior pedicle and (or) lateral mass fixation, and combined surgery was performed in ten patients. Ten patients (18.2%) with a poor outcome were observed after first surgery. Among them, 3 patients treated with a single anterior surgery had persistent or aggravated radiculopathy and posterior approach surgery with ipsilateral facet resection, foramen enlargement, and pedicle and (or) lateral mass screw fixation was performed immediately, 5 patients treated with a short-segment posterior surgery showed mild late kyphosis deformity, and 2 patients with vertebral malalignment were encountered after anterior single-level fusion during the follow-up. This retrospective study indicated that UCLF is a rotationally unstable cervical spine injury. The classification proposed in this study will contribute to understanding the injury mechanism, radiological characteristics, and neurological deficits in various types of UCLF, which will help the surgeons to evaluate the preoperative closed reduction and guide the selection of surgical approach and fusion segment.

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“…12 Xinjia wang in 2018 concluded that closed reduction of bilateral locked facet joints of the lower cervical spine is possible, but reduction of unilateral locked facet joints of the lower cervical spine (ULFJLCS) is challenging. 13 In 2016 Soumyajit Basu in his study concluded that preoperative traction is a safe and effective initial treatment for neglected cervical facet dislocation, as it reduces the need for extensive (anterior and posterior) surgery. 14 As per the above studies, simple conclusion can be derived that manipulations are very effective in treating locked facet joint.…”

Section: Discussionmentioning

confidence: 99%

Impact of a Comprehensive Physiotherapy on a Complex Case of Locked Facet Joint: A Case Report

Indrani Gurjalwar,

Gouri Kalaskar,

Mitushi Deshmukh

et al. 2021

Indian Journal of Forensic Medicine & Toxicology

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Introduction -Locked facet joint is a type of facet joint dislocation which occurs due to jumping of the inferior articular process over the superior articular process of the vertebra below and causes locking in that position. It can be unilateral or bilateral. In case of unilateral facet joint locking mechanism is flexion/ distraction and rotation. Only 30% of cases associated with neurologic defect. Most often it occurs at C4-5 and C5-6 level. Inferior articular facet of superior vertebral body is locked in front of the superior facet of the more inferior vertebral body but only on one side. X-ray Image Findings in such cases are -subtle, slight anterior subluxation of one vertebral body on the one below usually less than 25% of the width. On lateral view of cervical spine, some bodies appear true lateral below level of injury and oblique above level of injury that is the "Bow-tie sign". Spinous processes do not align on frontal film. Spinous processes of inferior vertebrae displace toward the locked side. In case of bilateral facet joint locking there is always a history of severe flexion injury. Both anterior and posterior ligamentous structures are disrupted at site of injury. More superior vertebra subluxes forward by 50% or more of the body below. Usually occurs in lower cervical spine. Generally, facet locking is a rare occurrence. Case Description -a case of 43 years old female is presented in the report who presented with pain and stiffness in neck which was sudden in onset was present since last two days. Assessment, patient's history and treatment have been discussed in the case study. Conclusion -This case study concluded that there is a significant effect of the given therapeutic intervention on pain, range of motion and activities of daily living (ADL) of the patient.

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New reduction technique for the treatment of unilateral locked facet joints of the lower cervical spine

Abstract: These data demonstrate that our new reduction technique is a simple, safe, and effective treatment for ULFJLCS.

Cited by 7 publications

References 30 publications

Subaxial Cervical Spine Injuries: WFNS Spine Committee Recommendations

Subaxial Cervical Spine Injuries: WFNS Spine Committee Recommendations

Classification of unilateral cervical locked facet with or without lateral mass-facet fractures and a retrospective observational study of 55 cases

Impact of a Comprehensive Physiotherapy on a Complex Case of Locked Facet Joint: A Case Report

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