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270-Degree Decompression, Fixation, and Realignment in a Neglected Cervical Facet Dislocation : A Case Report
Ahmed J Zahrani1, Menatalla Metwally Said ElBadawy2, Amgad M Elshoeibi3
1Department of Neurosurgery, Security Forces Hospital, Riyadh, Saudi Arabia.
Study Design:
Case report.
Objective:
To describe the surgical strategy and clinical outcome of a single-session 270-degree decompression, fixation, and realignment procedure for a neglected subaxial cervical facet dislocation.
Summary Of Background Data:
Neglected cervical facet dislocations are rare but challenging injuries that often present with chronic pain, neurological deficit, and fixed kyphotic deformity. Delayed management is complicated by facet fusion, spinal cord compression, and loss of reduction potential, frequently necessitating complex circumferential reconstruction strategies.
Methods:
A 22-year-old male presented 1 year after a road traffic accident with persistent neck pain, radiculopathy, bilateral upper limb weakness, and gait imbalance. Computed tomography and magnetic resonance imaging demonstrated C3-C4 anterolisthesis with right-sided facet fusion, a locked facet on the left, and severe canal stenosis with cord compression and cord signal changes. Under neurophysiological monitoring, a single-session circumferential "270 degrees" procedure was performed: posterior partial facetectomy and unilateral lateral mass screw fixation, followed by anterior C4 corpectomy, decompression, cage insertion with plating, and completion of posterior rod fixation for definitive stabilization and realignment.
Results:
The patient tolerated the procedure without intraoperative complications. Postoperatively, he experienced marked improvement in radicular pain, handgrip strength, and gait stability. Follow-up radiographs confirmed restoration of cervical alignment and correction of lordosis, and he continued to demonstrate neurological recovery with a structured rehabilitation program. At 3-year follow-up, the patient remained neurologically intact with mild intermittent neck pain and stable radiographic alignment.
Conclusions:
A carefully planned single-stage 270-degree decompression and fusion strategy can provide effective neural decompression, correction of deformity, and restoration of mechanical stability in neglected cervical facet dislocations, enabling meaningful neurological recovery. Early recognition and careful preoperative planning of circumferential surgery are particularly important in settings where delayed presentation is common.