Traumatic Sub Axial Cervical Facet Subluxation and Dislocation: Comparison between Surgical Approaches and Outcome
Maged Abdullah Matter *
Neurosurgery Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
Mohamed Saad Abdelaziz
Neurosurgery Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
Osama Elfahl
Neurosurgery Department, Faculty of Medicine, Beni Suef University, Beni Suef, Egypt.
*Author to whom correspondence should be addressed.
Abstract
Background: Subaxial cervical spine fractures and dislocations are comparatively uncommon but potentially fatal injuries. Because of their inherent instability, they are often linked to neurologic impairment that necessitates immediate surgical intervention. This work aim was to compare between different surgical approaches, and their outcome in Traumatic sub axial cervical facet subluxation and dislocation.
Methods: This prospective clinical study was conducted on 52 cases aged from 11 to 75 years old, both sexes, with traumatic sub-axial cervical sub-laxation or dislocation “unilateral or bilateral. All patients underwent a general examination, clinical assessment, and history-taking., examination of associated injuries utilizing ASIA grading and ISNCSCI standards for neurological, and spinal examination, routine laboratory investigations, and neuroimaging [Multi-slice CT cervical spine, and MRI cervical evaluation].
Results: There was significant difference regarding the relation between the surgical approaches and the ASIA (p=0.012). After 6 months, total mortalities of patients operated via combined approach was 4 (33.3%), 4 (12.5%) of patients operated via anterior approach, no mortalities in patients operated via posterior approach, this is statistically significant (P = 0.049). There was statistically significant difference regarding the relation between ASIA score and laterality, and late mortality and morbidity with p value (p=0.001).
Conclusions: Regarding Surgical approaches include all approaches are safe and sufficient in reduction and fixation of the dislocated facets with very close clinical & radiological successful rates. When selecting an approach, it is crucial to consider the sagittal alignment of the cervical vertebrae.
Keywords: Traumatic subluxations spine fractures, dislocation, surgical approaches