Dislocations of the lower cervical spine

Area of Science:

• Orthopedics
• Neurosurgery
• Spinal Surgery

Background:

• Cervical spine facet dislocations present a significant challenge in orthopedic and neurosurgical management.
• Treatment strategies have evolved, with varying success rates for closed versus open reduction techniques.

Purpose of the Study:

• To evaluate the efficacy of closed reduction and halo thoracic bracing for cervical spine facet dislocations.
• To identify patient subgroups at higher risk of treatment failure and long-term complications.

Main Methods:

• Retrospective analysis of 34 cervical spine facet dislocation cases treated between 1975 and 1979.
• Comparison of outcomes between closed reduction with halo thoracic immobilization and open reduction with fusion.

Main Results:

• Closed reduction and halo thoracic immobilization showed a high failure rate, particularly in patients with minimal or no neurologic deficit.
• Bilateral facet dislocations were more commonly associated with severe neurologic injury compared to unilateral dislocations.
• Closed reduction was time-consuming, often unsuccessful, and carried a risk of neurologic deterioration.

Conclusions:

• Patients with cervical facet dislocations and minimal neurologic injury are at risk of late instability after halo thoracic bracing.
• Open reduction and posterior cervical fusion may be advisable for select patients to prevent late instability.
• Surgical fusion should be reserved for patients at risk of instability due to the high incidence of long-term neck pain and stiffness.