Clinical Outcome of lateral mass screws for traumatic sub-axial facet dislocation

This study aimed to analyze the functional and neurological outcome of patients diagnosed with subaxial cervical spine bilateral facet dislocation managed by standard posterior midline approach and lateral mass screw fixation by Margerl technique.

We retrospectively evaluated 22 patients with traumatic cervical spine injuries who presented at the Orthopaedics and Spine Centre Ghurki Trust Teaching Hospital, Lahore from March 2020 to October 2023. Patients included in this study who has subaxial cervical spine bilateral facet dislocation managed by standard posterior midline approach and lateral mass screw fixation by Magerl technique. Functional outcomes was assessed by neck disability index and ASIA impairment scale at last follow up. Preoperative and post operative neurological status was evaluated with ASIA impairment scale. All the data were analyzed using SPSS version 23.

Total 22 patients participated in the study of which 72.73% were male and 27.27% female. Mean age was 39±17.02(13-70) years. Regarding level of dislocation, most common level was C5-6 which was involved in 12 patients, followed by C3-4 and C4-5 which was involved in five patients each. Pre-operatively 50% of the patients had intact neurology (ASIA E), followed by ASIA D which made up of the 27.27% patients, ASIA C 9.09%, ASIA B patients (4.55%), ASIA A 9.09% illustrating the severity of the neurological dysfunction. Postoperatively no neurological recovery was observed in ASIA A or ASIA B patients, while all ASIA C and D patients showed complete recovery. Mean Neck Disability Index (NDI) was 21±19.44.

After a good reduction, lateral mass screws fixation are a safe and reliable approach for cervical fixation that not only stabilizes the cervical spine but also leads to a patient's excellent functional recovery.