One-stage open reduction of an old cervical subluxation: case report

Study Design Case report. Objective The recommended treatment of cervical subluxation is currently closed or open reduction. These treatments are better accomplished in the acute setting, when muscular and ligamentous laxity allows the required maneuvers to realign the dislocated segments. However, subsets of patients are still being treated subacutely. The majority of the literature addressing subacute subluxations reports treatment through "front and back" approaches, many of them performed in two, three, or even four stages. Other authors recommend days or weeks of traction to reduce the subluxation, followed by anterior or posterior approaches. Herein, we present a one-stage open posterior surgical treatment of a 2-month standing C5-C6 subluxation with "jumped facets," describing a useful technique to reduce these challenging cases without the need of traction or multistage procedures. Methods After opening and exposing the posterior elements, we performed a wide C5-6 bilateral foraminotomy; we then put lateral mass screws and rods from C4 to C6. Resembling the technique used in the reduction of high-grade lumbar spondylolisthesis, we used a rod reducer to bring back the C5 screw head toward the rod, thus realigning the lateral mass screw heads and reducing the subluxation. Results No changes were observed in the motor evoked or somatosensory potentials during this maneuver. Following an uneventful procedure, the patient was transferred to the postanesthetic care unit and discharged 3 days later. Conclusions This open single-stage posterior approach dramatically reduces operating time. This technique could be added into the decision-making armamentarium for cases without disk herniation.