Posterior-anterior approach in treatment of irreducible traumatic spondylolisthesis of lower cervical vertebrae combined with facet dislocation / 中国矫形外科杂志

ABSTRACT

[Objective]To introduce the clinical experiences and efficiency in surgical treatment of irreducible traumatic spondylolisthesis of lower cervical vertebrae combined with facet dislocation with decompression,reduction and internal fixation through anteroposterior approaches.[Methods]A total of 34 cases of irreducible traumatic spondylolisthesis of lower cervical vertebrae combined with facet dislocation(25 males and 9 females,with age range of 21-61 years)treated from October 2005 to February 2009 were analyzed.Twenty-one cases showed double joints interlocking and 13 cases single facet joint interlocking,which was indentified by the three dimensional CT scan.All cases were treated with decompression,reduction and internal fixation through anteroposterior approach.Among them,13 cases were done through one stage anterior delompression,posterior unlock,fusion and stabilization as well as anterior fusion and stabilization in turn,21 cases were done through one stage posterior unlock,fusion and stabilization as well as anterior decompression,fusion and stabilization in turn.The Frankel grade scores was used as the judging criteria for the recovery of the spinal cord.[Results]All patients were followed up from 7 to 35 months,and the mean follow-up time was 16 months.Lateral mass screw and pedicle screw insertion were successful in all cases.After operation,the joint interlocking and dislocation were all released and reduced.There were no death,infection,interfixation failure or neurological function deterioration.Solid fusion were obtained in all cases in the follow-up.Incomplete spinal cord lesions had some recovery of nervous function postoperatively.Besides,one grade was improved in 23 cases by Frankel grade scores and 2 grades in 8 case.There were no improvements in 3 cases.[Conclusion]Decompression,reduction and internal fixation through anteroposterior approaches is an appropriate treatment method for the irreducible traumatic spondylolisthesis of lower cervical vertebrae combined with facet disclocation,with the advantages of relatively safe operation and strong stability.Most complications can be prevented under correct control of anatomic features and adjacent structures of the cervical lateral mass and pedicle as well as careful operation.