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SA Orthopaedic Journal

On-line version ISSN 2309-8309

Abstract

DU TOIT, Albert B  and  DUNN, Robert. Bifacet dislocations of cervical spine: Acute management and outcome. SA orthop. j. [online]. 2008, vol.7, n.4, pp. 30-36. ISSN 2309-8309.

INTRODUCTION: Although the goal in treating bilateral facet dislocations remains the early realignment of the spine, there is controversy regarding the timing and method of reduction, as well as the optimal approach for stabilisation. A retrospective analysis of prospective collected data from 36 consecutive patients treated for bilateral cervical facet dislocations (BCFD) at the Groote Schuur Hospital Acute Spinal Cord Injury Unit (ASCI) is presented. METHODS: Case notes and radiographs of 36 BCFD patients managed from April 2003 to January 2007 were reviewed with reference to reduction, stabilisation, radiographic measurements, union, neurology and complications. RESULTS: There were 27 males and 9 females. MVAs were the cause in 26 cases. C6/7 was the commonest level of dislocation, followed by C5/6. Seventy-five per cent of the patients had a complete neurological deficit, with only three limited to radiculopathy. Thirteen out of 21 had successful closed reductions, while 14/17 underwent successful open reduction via an anterior approach. Anterior cervical discectomy and fusion (ACDF) was utilised in 25 cases, posterior fixation in five, anterior and posterior in four, and conservative management in two cases. There were three cases of fixation failure, with two requiring revision. There were two transient recurrent nerve palsies but no sepsis. There was a 100% confirmed union rate. There were three deaths related to respiratory compromise. There was no difference in outcome between the posterior and anterior approaches. Although only a few patients improved neurologically, there were no patients with deteriorating motor function at last follow-up. CONCLUSION: Early aggressive surgical management for cervical bifacet dislocations yields good results. Open reduction followed by immediate stabilisation by ACDF is highly successful in the acute case and obviates the need for traction and possible associated neurological complications. In highly unstable cases or cases with poor screw purchase, supplemental posterior fixation may be required. Posterior alone surgery is occasionally indicated, such as delayed presentation and cervico-thoracic junction. Closed reduction with delayed stabilisation remains an acceptable option in the resource-restricted environment.

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