Treatment of cervical dislocation with locked facets.

BACKGROUND: Lower cervical dislocation with locked facets is common in cervical injury. The locked facets include unilateral and bilateral types. Different successful closed reduction rates has been achieved between unilateral and bilateral types by using rapid skull traction, which was commonly used to reduce the cervical dislocation. It is important to investigate a suitable management specific to patients with different types of cervical locked facets. METHODS: A total of 38 patients with cervical dislocation with locked facet due to cervical injury treated by rapid skull traction and operation from 1988 to 2005 were reviewed. Rapid skull traction was used in all the patients. Successful closed reduction rate was 88.0% in patients with bilateral cervical locked facets and that was 15.4% in those with unilateral cervical locked facets. These data were then statistically compared by Chi-square test. Patients who were reduced successfully underwent anterior cervical discectomy and fusion at the injured level, and those who failed in closed reduction received posterior open reduction and fixation. RESULTS: In this series, there was statistically significant difference (P < 0.05) in the rate of successful closed skull traction reduction between unilateral and bilateral locked facets dislocation. Unilateral cervical locked facets dislocation was not easily reduced by skull traction which was suitable for reduction of bilateral cervical locked facets dislocation. However, unilateral cervical locked facets dislocation can be reduced by posterior open reduction. CONCLUSIONS: Unilateral cervical locked facets dislocation should be treated immediately with posterior open reduction and instrumentation. Bilateral cervical locked facets dislocation can be reduced by rapid skull traction firstly and anterior cervical discectomy and interbody fusion later.

[Single-stage combined anterior-posterior instrumentation for multiple level cervical spine fractures].

OBJECTIVE: To investigate the efficacy of single-stage combined anterior-posterior instrumentation for treatment of multiple level cervical spine fractures. METHODS: Nine patients with multiple-level fractures of the cervical spine, 8 males and 1 female aged 24 - 63, underwent ingle-stage combined anterior-posterior instrumentation. Seven patients with multiple contiguous fractures of the cervical spine were treated with anterior decompression and plating combined with posterior cervical lateral mass screw fixation; and 2 patients with non-contiguous cervical fractures, both with type II odontoid fracture and lower cervical fracture, were treated with both anterior odontoid screw and posterior cervical lateral mass screw fixation. Cranioskeletal traction with a weight of 5 kg was done before the operation. Follow-up was conducted for 31 months. ASIA motor scores were used to evaluate the neural function. RESULTS: Satisfactory reduction and fusion were obtained without any complication, and the neural function was improved. Nerve root function recovered in two patients and one patient's spinal cord function became normal. The average ASIA score was 63.8. CONCLUSION: A feasible option in the treatment of multiple level cervical spinal fractures, single-stage combined anterior-posterior instrumentation provides decompression and stabilization in a short time and helps the neural function to recover.

[Clinical diagnosis and treatment of multiple-level injuries of the cervical spine].

OBJECTIVE: To investigate the character, diagnosis and treatment of multiple-level fractures of the cervical spine. METHODS: Forty-three patients (38 male, 5 female) with multiple-level fractures of the cervical spine were retrospectively analysed in our hospital from 1988-2001. RESULTS: Among 36 patients with multiple contiguous fractures of the cervical spine, 32 cases were injured at low cervical spine; 7 patients were non-contiguous spinal fractures in which there were 5 cases injured at upper and lower cervical spine. The frequently injured sites were vertebral body (31 patients), laminae (25 patients), spinous process (9 patients), vertebral arch (4 patients), transverse process (5 patients), lateral mass (5 patients); level frequently affected were C(4), C(5), C(6) and C(7); 21 patients were treated with anterior vertebrectomy and fusion, 10 patients with posterior laminectomy and fixation, 2 patients with both anterior and posterior decompression and fixation. 60.5% were flexion-compression injury. 10 patients with conservative treatment. CONCLUSIONS: Contiguous type was more common than non-contiguous type in multiple level cervical spinal fractures; Injured sites always located at lower cervical spine in contiguous cervical fractures different from that fractures of atlas, axis and lower cervical spine in non-contiguous type; Unstable segments and level of spinal cord injury were at lower cervical spine; Operations must obtain both decompression and stability of spine.

[Clinical diagnosis and treatment of Hangman's fracture].

OBJECTIVE: To investigate the mechanism of Hangman's fracture and its clinical manifestation and treatment. METHODS: Ten patients with Hangman's fracture treated at our hospital from 1988 to 2001 were analysed. RESULT: Patients were injured by motor vehicle accidents (7 patients), object hitting on the head (1), and fall (1). Injuries were classified as type I (1 patient), type II (5), type IIa (2) and type III (2). CONCLUSIONS: Motor vehicle accident and fall are major causes of Hangman's fracture with neurological deficits but limited motion and neck pain. Hangman's fracture is easily diagnosed using lateral cervical X-ray and CT. Hangman's fractures of types I, II and IIa can be treated conservatively, but those of type III or spinal cord injury require surgical stabilization.