Current research on unilateral cervical facet dislocation of the lower cervical spine / 中华创伤骨科杂志

Unilateral facet dislocation of the lower cervical spine is an important subgroup of cervical spine injuries,accounting for from 12％ to 16％ of all cervical spine injuries.Unilateral facet dislocation occurs the most commonly at the C5-6 level,and is closely related to the anatomic and morphometric features of the cervical facet.This injury has been attributed to combined flexion and rotation,but it remains unclear whether flexion or rotation is the component of greater importance.Its treatment includes nonoperative and operative measures but optimal treatment has not been established.It is generally accepted that a recommendable treatment protocol begins with closed reduction and proceeds depending on whether the closed reduction succeeds and traumatic disc herniation is present or not.

Regrowing Synovial Chondromatosis in a Cervical Facet Joint with Radiculopathy

Synovial chondromatosis (SC) in the spine is rare. There are few reports of associated cervical radiculopathy and there has not been a case reported of regrowing cervical SC. Here we report a 21-year-old man with a SC of a cervical facet joint that extended into the intervertebral foramen and compressed the cervical nerve root. The same symptom developed three years following the first operation. Computed tomography (CT) scans and Magnetic resonance imaging (MRI) showed multiple calcified nodules anterior to the right facet joint of C6-7 that extended into the intervertebral foramen. A mass removal was performed just as in the previous operation with a subtotal facetectomy. When vertebral SC is suspected, complete removal involving the bone and synovium should be considered as the standard treatment option.

A new method for stimulation of cervical facet joint under ultrasonographic guidance

BACKGROUND: Cervical facet joint needling and stimulation is useful for the management of cervical facet arthropathy, but a direct needling of the joint may injure the capsule and cause post-needling pain.We developed a new approaching technique for cervical facet joint needling and stimulation. METHODS: We retrospectively reviewed medical records of 24 patients with cervical facet arthropathy who underwent facet joint needling and stimulation through oblique posterior approach.Under ultrasonographic guidance, a specially designed dry needle (Ahn's needle) was inserted at midline of posterior neck and advanced obliquely to posterior and lateral side of facet joint.The procedure was completed when a marked reduction in resistance was felt at the tip of the needle.Follow-ups using the numeric rating pain scale (NRS) and the rate of self-rated improvement were conducted at three weeks and about three months after last treatment by telephone interview. RESULTS: Among them, 23 patients were enrolled.The average of NRS decreased from 6.8 +/- 3.0 to 2.7 +/- 3.0 at 3 weeks and to 2.9 +/- 2.0 at 3 months after the last treatment (P < 0.05).The average rate of self-rated improvement was 63.7 +/- 7.2 and 61.6 +/- 3.0% at 3 weeks and 3 months after the last treatment respectively. CONCLUSIONS: Our result suggested that this technique for dry needling around cervical facet joint under ultrasound guidance is one of the successful options to treat neck pain derived from facet joint.

A Biomechanical Comparison among Three Surgical Methods in Bilateral Subaxial Cervical Facet Dislocation

OBJECTIVE: The biomechanical stabilities between the anterior plate fixation after anterior discectomy and fusion (ACDFP) and the posterior transpedicular fixation after ACDF(ACDFTP) have not been compared using human cadaver in bilateral cervical facet dislocation. The purpose of this study is to compare the stability of ACDFP, a posterior wiring procedure after ACDFP(ACDFPW), and ACDFTP for treatment of bilateral cervical facet dislocation. METHODS: Ten human spines(C3-T1) were tested in the following sequence: the intact state, after ACDFP(Group 1), ACDFPW(Group 2), and ACDFTP(Group 3). Intervertebral motions were measured by a video-based motion capture system. The range of motion(ROM) and neutral zone(NZ) were compared for each loading mode to a maximum of 2.0Nm. RESULTS: ROMs for Group 1 were below that of the intact spine in all loading modes, with statistical significance in flexion and extension, but NZs were decreased in flexion and extension and slightly increased in bending and axial rotation without significances. Group 2 produced additional stability in axial rotation of ROM and in flexion of NZ than Group 1 with significance. Group 3 provided better stability than Group 1 in bending and axial rotation, and better stability than Group 2 in bending of both ROM and NZ. There was no significant difference in extension modes for the three Groups. CONCLUSION: ACDFTP(Group 3) demonstrates the most effective stabilization followed by ACDFPW(Group 2), and ACDFP(Group 1). ACDFP provides sufficient strength in most loading modes, ACDFP can provide an effective stabilization for bilateral cervical facet dislocation with a brace.

Disc Extrusion on Lower Cervical Facet Joint Fracture - Dislocation / 대한정형외과학회잡지

PURPOSE: To evaluate the incidence of disc extrusion and neurologic deficit, the relation between disc extrusion and neurologic deficit and the treatment results according to our basic treatment principles in lower cervical facet joint fracture and dislocations MATERIALS AND METHODS: Twelve patients were evaluated, 8 male and 4 female with an average age of 41 years comprised the group. Six injuries were attributable to automobile accidents, 5 to fall from building, bed, floor and hill, and one to stand on her head. One case was distractive-flexion stage (DFS) 1, 9 cases with DFS 2 and 2 cases with DFS 3. Plain X-ray, CT, Myelo CT and MRI were used as a diagnostic tools. As a treatment criteria, feasibility of closed reduction, status of neuroglogic injury, and stability of injured spine were considered. Anterior cervical discectomy and fusion in accompanied disc extrusion, posterior reduction and fusion with triple wiring in unreduced dislocation, and anterior decompression and fusion in incomplete cord and root injury were selected as a basic treatment principles. RESULTS: Ten out of 12 cases (83%) showed neurologic deficits, 2 complete cord injury, 1 incomplete cord injury, and 7 radiculopathy. Nine out of 12 (75%) demonstrated disc extrusion and all disc extruded patients had neurologic deficits. Anterior cervical discectomy and fusion (ACDF) were performed in 5 cases, ACDF and posterior reduction with triple wiring (PRTW) in 4 cases, PRTW in 1 case, and skull traction and philadelphia brace in 2 cases. Seven radiculpathy patients were completely recovered and one incomplete cord injury patient can ambulate with spastic gait after surgery. There were 2 bed sore and 1 pneumonia in complications. CONCLUSION: Soft disc extrusion should be evaluated carefully with MRI and CT in lower cervical spine injury with the facet joint fracture-dislocations before the decision of treatment. As disc extrusion always accompanies neurologic deficit, it must be surgically treated by anterior cervical discectomy and fusion.