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Anterior Approach Following Intraoperative Reduction for Cervical Facet Fracture and Dislocation

Journal of Korean Neurosurgical Society 2020년 63권 2호 p.202 ~ 209
김슬기 ( Kim Seul-Gi ) - Chosun University College of Medicine Department of Neurosurgery

박선주 ( Park Seon-Joo ) - Chosun University College of Medicine Department of Natural Medical Sciences
왕희선 ( Wang Hui-Sun ) - Chosun University College of Medicine Department of Neurosurgery
주창일 ( Ju Chang-Il ) - Chosun University College of Medicine Department of Neurosurgery
이성명 ( Lee Sung-Myung ) - Chosun University College of Medicine Department of Neurosurgery
김석원 ( Kim Seok-Won ) - Chosun University College of Medicine Department of Neurosurgery

Abstract


Objective: The purpose of this study was to evaluate the efficacy of the anterior approach following intraoperative reduction under general anesthesia in patients with cervical facet fracture and dislocation.

Methods: Twenty-three patients with single level cervical facet fracture and dislocation who were subjected to the anterior approach alone following immediate intraoperative reduction under general anesthesia from March 2013 to December 2017 were enrolled in this study. Neurological status, clinical outcome, and radiological studies were evaluated preoperatively, postoperatively, and during the follow-up period.

Results: The cohort comprised 15 men and eight women with a mean age of 57 years (from 24 to 81). All patients were operated on within the first 8 hours following the injury. After gentle manual reduction or closed reduction with Gardner-Wells traction, under general anesthesia monitored by somatosensory-evoked potentials, all operations were successfully completed using the anterior approach alone except in two patients, who had a risk of over-distraction. In them, a satisfactory gentle manual reduction or closed reduction was not possible, and required open posterior reduction of the locked facets followed by anterior cervical discectomy and fusion. In one patient, screw retropulsion was observed in 1 month after surgery. There were no reduction-related complications or neurological aggravations after surgery. All patients showed evidence of stability at the instrumented level at the final follow-up (mean follow-up, 12 months).

Conclusion: Anterior approach following intraoperative reduction monitored by somatosensory-evoked potentials under general anesthesia for cervical dislocation and locked facets is a relatively safe and effective alternative when cervical alignment is achieved by intraoperative reduction.

키워드

Cervical vertebra; Fracture dislocation
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