The impact of traumatic herniated discs in cervical facets dislocations treatments: systematic review and meta-analysis

Onishi, Franz Jooji; Daniel, Jefferson Walter; Joaquim, Andrei Fernandes; Evangelista, Alécio Cristino; Bertolini, Eduardo de Freitas; Dantas, François; Neto, Eloy Rusafa; Mudo, Marcelo Luiz; Brock, Roger Schmidt; Milano, Jerônimo Buzetti; Botelho, Ricardo Vieira

doi:10.1007/s00586-022-07290-z

Cited by 5 publications

(4 citation statements)

References 27 publications

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“…However, the repair did not exacerbate their neurological symptoms, and all patients had these disk abnormalities resolved following the reduction [26]. A previous systematic review also noted that neurological worsening after spinal realignment with cranial-cervical traction was rare [27]. In this research, there were no cases of permanent worsening of the neurological symptoms owing to closed reduction, and we believe that this procedure can be carried out safely.…”

Section: Discussionsupporting

confidence: 55%

Immediate Closed Reduction Technique for Cervical Spine Dislocations

Oae¹,

Kamei²,

Sawano³

et al. 2023

Asian Spine J

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Study Design: Retrospective study.Purpose: This research aimed to assess the clinical outcomes of patients with traumatic cervical spine dislocation who underwent closed reduction employing our approach.Overview of Literature: Bedside closed reduction is the quickest procedure for repairing traumatic cervical spine dislocations; nevertheless, it also possesses the risk of neurological deterioration.Methods: For closed reduction, the patient’s head was elevated on a motorized bed, the cervical spine was placed at the midline, traction of 10 kg was applied, the motorized bed was gradually returned to a flat position, the head was lifted off the bed, and the cervical spine was slowly adjusted to a flexed position. The weight of traction was elevated by 5-kg increments until the positional shift was attained. Subsequently, the bed was gradually tilted while traction was applied again to return the cervical spine to the midline position.Results: Of the 43 cases of cervical spine dislocation, closed reduction was carried out in 40 cases, of which 36 were successful. During repositioning, three patients experienced a temporary worsening of their neck pain and neurological symptoms that enhanced when the cervical spine was flexed. Closed reduction was conducted while the patient was awake; nevertheless, sedation was needed in three cases. Among the 24 patients whose pretreatment paralysis had been characterized by American Spinal Injury Association Impairment Scale (AIS) grades A–C, seven patients (29.2%) demonstrated an enhancement of two or more AIS grades at the last observation.Conclusions: Our closed reduction approach safely repaired traumatic cervical spine dislocations.

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Section: Discussionsupporting

confidence: 55%

Immediate Closed Reduction Technique for Cervical Spine Dislocations

Oae¹,

Kamei²,

Sawano³

et al. 2023

Asian Spine J

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“…MRI is the method of choice to evaluate the severity of canal stenosis and detect spinal cord injury and potentially harmful associated disc herniation [ 17 , 18 ]. Here, MRI confirmed the dislocation, ruled out disc herniation, showed severe cord compression, and established myelopathy.…”

Section: Discussionmentioning

confidence: 99%

Non-traumatic complete cervical spine dislocation with severe fixed kyphosis: successful multidisciplinary approach to a challenging case

Lecouvet,

Geradon,

Banse

et al. 2024

J Med Case Reports

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Background To our knowledge, there is no previous report in the literature of non-traumatic neglected complete cervical spine dislocation characterized by anterior spondyloptosis of C4, extreme head drop, and irreducible cervicothoracic kyphosis. Case presentation We report the case of a 33-year-old Caucasian man with a 17-year history of severe immune polymyositis and regular physiotherapy who presented with severe non-reducible kyphosis of the cervicothoracic junction and progressive tetraparesia for several weeks after a physiotherapy session. Radiographs, computed tomography, and magnetic resonance imaging revealed a complete dislocation at the C4–C5 level, with C4 spondyloptosis, kyphotic angulation, spinal cord compression, and severe myelopathy. Due to recent worsening of neurological symptoms, an invasive treatment strategy was indicated. The patient’s neurological status and spinal deformity greatly complicated the anesthetic and surgical management, which was planned after extensive multidisciplinary discussion and relied on close collaboration between the orthopedic surgeon and the anesthetist. Regarding anesthesia, difficult airway access was expected due to severe cervical angulation, limited mouth opening, and thyromental distance, with high risk of difficult ventilation and intubation. Patient management was further complicated by a theoretical risk of neurogenic shock, motor and sensory deterioration, instability due to position changes during surgery, and postoperative respiratory failure. Regarding surgery, a multistage approach was carefully planned. After a failed attempt at closed reduction, a three-stage surgical procedure was performed to reduce displacement and stabilize the spine, resulting in correct spinal realignment and fixation. Progressive complete neurological recovery was observed. Conclusion This case illustrates the successful management of a critical situation based on a multidisciplinary collaboration involving radiologists, anesthesiologists, and spine surgeons.

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“…4 Fallbeispiel einer unilateralen, nicht dislozierten Facettenfraktur HWK 7 (AO Spine F1). Die Fragmentgröße beträgt mit 8,4 mm weniger als 40% der kontralateralen Massa lateralis (23,7 mm aber in nur 0,5% der Fälle zu einer neurologischen Verschlechterung bei geschlossener oder dorsal offener Reposition mit bekanntem traumatischen Bandscheibenvorfall [65]. Eine Verzögerung der operativen Therapie durch diese diagnostische Maßnahme sollte daher nicht akzeptiert werden.…”

Section: Operative Therapieunclassified

Verletzungen der subaxialen Halswirbelsäule

Schleicher,

Pingel,

Neuhoff

et al. 2024

Die Wirbelsäule

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ZusammenfassungDie untere Halswirbelsäule (HWS) ist anfällig für Verletzungen, die 2,5–5% aller knöchernen Verletzungen ausmachen. Statistiken zeigen, dass 20–50% aller Wirbelsäulenverletzungen die HWS betreffen, wobei 50–70% auf die untere HWS entfallen. In Deutschland gab es 2018 rund 11.528 stationäre Behandlungen aufgrund von Halswirbelsäulenfrakturen, mit steigender Tendenz.Rückenmarkverletzungen bei HWS-Verletzungen treten mit etwa 10–12% auf, wobei das Risiko im Vergleich zu Brust- und Lendenwirbelverletzungen dreifach höher ist. Sportliche Aktivitäten, Verkehrsbeteiligung und Stürze über 2 m Höhe erhöhen das Risiko signifikant.Begleitverletzungen sind in bis zu 80% der Fälle vorhanden und betreffen andere Wirbelsäulenabschnitte, Schädel-Hirn-Trauma und Extremitäten. Die Segmente C5–6 und C6–7 sind am häufigsten betroffen.Die AO Spine-Klassifikation für subaxiale HWS-Verletzungen, eingeführt 2015, berücksichtigt Facettenverletzungen und neurologischen Status. Diagnostisch ist die Canadian-C-Spine-Rule relevant, während die CT für die primäre HWS-Bildgebung bevorzugt wird.Therapieoptionen umfassen konservative Ansätze für nicht dislozierte Frakturen, während operative Eingriffe, ventral oder dorsal, bei instabilen Verletzungen erforderlich sind. Die Wahl der Therapie hängt von verschiedenen Faktoren ab, darunter die Art der Verletzung und der neurologische Status.Die Prognose nach HWS-Verletzungen variiert je nach Grad der neurologischen Beteiligung. Ohne Rückenmarkverletzung erzielen die meisten Patienten gute Ergebnisse, während Rückenmarkverletzungen die Lebensqualität negativ beeinflussen. Die Rückkehr in den Beruf gelingt in vielen Fällen, und radikuläre Läsionen heilen häufig symptomfrei aus. Relevante Nackenschmerzen sind jedoch in etwa 20% der Fälle nach 2,5 Jahren zu verzeichnen.

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The impact of traumatic herniated discs in cervical facets dislocations treatments: systematic review and meta-analysis

Cited by 5 publications

References 27 publications

Immediate Closed Reduction Technique for Cervical Spine Dislocations

Immediate Closed Reduction Technique for Cervical Spine Dislocations

Non-traumatic complete cervical spine dislocation with severe fixed kyphosis: successful multidisciplinary approach to a challenging case

Verletzungen der subaxialen Halswirbelsäule

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