Anterior and Posterior Fusion on Reduction-failure Unilateral Interfacetal Dislocation

ABSTRACT

OBJECTIVE: Unilateral interfacetal dislocation(UID) is a common injury in cervical spine, but diagnosis is somewhat difficult due to mild subluxation. Management of'locked facet' is not established yet and many authors advocate posterior fusion to secure stability. Because most of UID patients have minimal neurological symptom with normal activity, we tried anterior and posterior fusion simultaneously. PATIENTS AND METHODS: Various parameters, such as the radiological findings, operation time and methods, kinds of fixation devices, post-operative stability, neurological outcomes in 10 UID-patients, who showed no satisfactory closed reduction with Gardner tong traction. These patients underwent anterior fixation following posterior open reduction and fusion to maintain the definite stability. RESULTS: Median age was 40 years(18-64 range) and the male to female ratio was 73. Causes of injury consisted of 6 car accident, 3 fall-down, 1 diving accident. Mechanism of injury was flexion in all ten cases. Levels of injury were 2 in C4-5, 5 in C5-6 and 3 in C6-7. Operations were performed within 5 days of injury in eight patients. In two patients, who had no reduction procedures were operated on the 23rd day and the 4th month respectively. Kinds of device were 7 titanium wire and 3 steel wire in posterior wiring, 9 Caspar nonlocking plate and 1 Orion locking plate in anterior plate fixation. All patients were ambulated at post-operative one day with Philadelphia cervical collar and showed post-operative stability with improved neurological outcome. CONCLUSION: In UID patients who failed in closed reduction with traction, anterior discectomy and bone fusion and plating following posterior open reduction and wiring proved good results.