Treatment of Subaxial Cervical Spinal Injuries

Gelb, Daniel E.; Aarabi, Bizhan; Dhall, Sanjay S.; Hurlbert, R. John; Rozzelle, Curtis J.; Ryken, Timothy C.; Theodore, Nicholas; Walters, Beverly C.; Hadley, Mark N.

doi:10.1227/neu.0b013e318276f637

Cited by 61 publications

(38 citation statements)

References 29 publications

(20 reference statements)

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“…However, previous studies report no differences between either approach in terms of neurological or radiological outcome. 4,7 The anterior approach is a familiar method and can be useful for the easy removal of herniated discs. 5,12,17,20,21 However, this approach is likely to be a better option when a closed reduction is successful.…”

Section: Discussionmentioning

confidence: 99%

A single-stage posterior approach with open reduction and pedicle screw fixation in subaxial cervical facet dislocations

Park

Roh

Rhim

2015

SPI

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OBJECT The optimal treatment for cervical facet dislocations is controversial, but the generally accepted process recommends an initial closed reduction with the next step determined according to the success of the closed reduction and the presence of traumatic disc herniation. This study aimed to show the efficacy of a posterior approach performed with an open reduction and pedicle screw fixation with removal of disc particles, if required, in the management of subaxial cervical dislocations. METHODS Between March 2012 and September 2013, 21 consecutive patients with cervical facet dislocations were enrolled. The affected levels were as follows: 4 at C3–4; 2 at C4–5; 5 at C5–6; and 10 at the C6–7 level. Seven patients had traumatic disc herniations. Closed reduction was not attempted; a prompt posterior cervical surgery was performed instead. After open reduction, pedicle screw fixation was performed. In cases with traumatic disc herniation, herniated disc fragments were excised via a posterolateral approach and successful decompressions were determined by postoperative MRI studies. Clinical outcomes were assessed using the American Spinal Injury Association (ASIA) grading system. Radiological outcomes were assessed by comparing the degree of subluxation and the angle of segmental lordosis between pre- and postoperative CT scans. RESULTS All patients improved neurologically. The mean segmental angles improved from 7.3° ± 8.68° to −5.9° ± 4.85°. The mean subluxation improved from 23.4% ± 16.52% to 2.6% ± 7.19%. Disc fragments were successfully removed from the 7 patients with herniated discs, as shown on MRI. CONCLUSIONS Open reduction followed by pedicle screw fixation or posterolateral removal of herniated disc fragments is a good treatment option for cervical facet dislocations.

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Section: Discussionmentioning

confidence: 99%

A single-stage posterior approach with open reduction and pedicle screw fixation in subaxial cervical facet dislocations

Park

Roh

Rhim

2015

SPI

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“…In fracture-dislocations of the spinal column, an additional decompression option is closed reduction with cervical traction. Evidence suggests that closed reduction is safe in awake patients without an additional rostral injury and effective in 80 % of cases [22]. However, the fear of disc herniation prevents many surgeons from performing a closed reduction without a pre-reduction MRI [23].…”

Section: Spinal Cord Decompressionmentioning

confidence: 99%

“…However, the fear of disc herniation prevents many surgeons from performing a closed reduction without a pre-reduction MRI [23]. These studies show herniated intervertebral discs in up to 55 % of cases, whereas the rate of permanent neurological deterioration following closed reduction is 1 %, although specific causes were not reported [22][23][24]. Although the current AANS/CNS Guidelines suggest that the utility of pre-reduction MRI in awake patients is uncertain, the authors suggest that closed reduction without pre-reduction MRI is the rational approach for these cases, given the impetus to decompress the spinal cord quickly and the potential for additional injury during transfers with an unstable C-spine.…”

Section: Spinal Cord Decompressionmentioning

confidence: 99%

Diagnosis and Acute Management of Spinal Cord Injury: Current Best Practices and Emerging Therapies

2015

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The diagnosis and management of spinal cord injury (SCI) have continuously evolved over decades of clinical experience. We now understand that the injured spinal cord is in a precarious state, experiencing a complex cascade of inflammatory events and hemodynamic compromise. Careful navigation is required at each stage, from emergency personnel to the spinal surgeon who reconstructs the damaged spine, to minimize secondary injury and optimize neurological outcome. Future advances in SCI diagnosis will likely utilize novel MRI techniques that characterize spinal cord microstructure and functional connectivity. The acute management of SCI is likely to undergo a radical transformation, with numerous potential treatments used in combination, such as neuroprotective and regenerative pharmaceuticals, cellular transplantation, and implantation of structural scaffolds. In this review, we summarize current best practices in diagnosis and acute management of SCI, highlight areas of controversy, and introduce emerging therapies that are candidates for translation to clinical use. neural damage, while the neuroregenerative agents act to promote axonal regrowth once damage has occurred. ATP adenosine triphosphate. Reprinted from Wilson JR, Forgione N, Fehlings MG. Emerging therapies for acute traumatic spinal cord injury. Figure 1.

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“…Anterior, posterior, anterior-posterior, anterior-posterior-anterior yaklaşımların hangi hastalara uygulanacağı konusunda ise tartışmalar halen devam etmektedir 10,11 .…”

Section: Introductionunclassified

Alt servikal omurganın travmatik kırık ve dislokasyonları: tek merkez bulguları

Özay

Hanalıoğlu

Güneş

et al. 2018

Cukurova Medical Journal (Çukurova Üniversitesi Tıp Fakültesi Dergisi)

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AbstractÖz Purpose: Traumatic injuries of the subaxial spine (C3-7) are among the most common and potentially most catastrophic injuries of axial skeleton. They occur with motor vehicle accidents in young and with falls in older population. In this study, we aimed to share our experiences with subaxial spinal injury patients surgically treated at our institution. Materials and Methods:We analyzed demographic, clinical and radiological data, surgical technique and results of 27 cases operated for traumatic fracture and dislocations of subaxial cervical spine. Subaxial Injury Classification and Severity Scale (SLICS) was used to assess severity of trauma and to guide surgical decision.

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Treatment of Subaxial Cervical Spinal Injuries

Cited by 61 publications

References 29 publications

A single-stage posterior approach with open reduction and pedicle screw fixation in subaxial cervical facet dislocations

A single-stage posterior approach with open reduction and pedicle screw fixation in subaxial cervical facet dislocations

Diagnosis and Acute Management of Spinal Cord Injury: Current Best Practices and Emerging Therapies

Alt servikal omurganın travmatik kırık ve dislokasyonları: tek merkez bulguları

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