Franz Jooji Onishi1, Jefferson Walter Daniel2, Andrei Fernandes Joaquim3, Alécio Cristino Evangelista4, Eduardo de Freitas Bertolini5, Fernando Rolemberg Dantas6, Eloy Rusafa Neto7, Marcelo Luiz Mudo8, Roger Brock7, Jerônimo Buzetti Milano9, Ricardo Vieira Botelho5. 1. Division of Neurosurgery, Federal University of São Paulo, UNIFESP, R. Borges Lagoa, 1080 sala 408, São Paulo, SP, CEP 04038-001, Brazil. franzonishi@gmail.com. 2. Division of Neurosurgery, School of Medical Sciences, Santa Casa de São Paulo, São Paulo, Brazil. 3. Division of Neurosurgery, University of Campinas (UNICAMP), Campinas, SP, Brazil. 4. Division of Surgery. Hospital, Universitario Lauro Wanderley. Federal University of Paraiba (UFPB), Joao Pessoa, PB, Brazil. 5. Division of Neurosurgery, Servidor Público Estadual Hospital, São Paulo, SP, Brazil. 6. São Luiz Department of Neurosurgery, Biocor Hospital, Rede D'Or, Belo Horizonte, MG, Brazil. 7. Neurology Department Division of Neurosurgery, University of São Paulo School of Medicine, São Paulo, Brazil. 8. Neurosurgeon CIENSA Institute São Paulo, São Paulo, Brazil. 9. Neurosurgeon Instituto de Neurologia de Curitiba, São Paulo, Brazil.
Abstract
BACKGROUND: Traumatic facet dislocations in the subaxial cervical spine, also known as locked facets, are commonly associated with neurological deficits. The fear of the presence of an associated traumatic disc herniation and consequent neurological worsening usually causes a delay in the spinal realignment. This study's aim is an analysis of safety and efficacy when treating acute cervical traumatic facet dislocations using cranial-cervical traction or posterior open reduction and fixation in the presence of disc herniations. METHODS: Inclusion criteria addressed the following patient groups: (1) MRI diagnosis of traumatic cervical facet dislocations with disc herniation, (2) intervention: either cranial-cervical traction or posterior open reduction and fixation, (4) neurological outcomes after treatment, (5) adult 18 plus years of age, (6) sample sizes greater than 20 patients, (7) English language publication. The following databases and search tools were analyzed: MEDLINE (PubMed), Cochrane Central Register of Controlled Trials (CENTRAL), Google Scholar, and the clinical trial registries (ClinicalTrials.gov), October 2021. RESULTS: Six studies were found, 2 with posterior open reduction and fixation and 4 with cranial-cervical traction, totalizing 197 patients. Neurological worsening was reported only in 1 case (0.5%). CONCLUSIONS: Traumatic disc herniation in cervical facet dislocations is not an absolute contraindication of cranial-cervical traction or posterior open reduction. Early realignment of the spine could bring more neurological benefits than waiting for an MRI or surgical discectomy. However, caution is needed in this review's data interpretation until prospective and well-designed studies are performed.
BACKGROUND: Traumatic facet dislocations in the subaxial cervical spine, also known as locked facets, are commonly associated with neurological deficits. The fear of the presence of an associated traumatic disc herniation and consequent neurological worsening usually causes a delay in the spinal realignment. This study's aim is an analysis of safety and efficacy when treating acute cervical traumatic facet dislocations using cranial-cervical traction or posterior open reduction and fixation in the presence of disc herniations. METHODS: Inclusion criteria addressed the following patient groups: (1) MRI diagnosis of traumatic cervical facet dislocations with disc herniation, (2) intervention: either cranial-cervical traction or posterior open reduction and fixation, (4) neurological outcomes after treatment, (5) adult 18 plus years of age, (6) sample sizes greater than 20 patients, (7) English language publication. The following databases and search tools were analyzed: MEDLINE (PubMed), Cochrane Central Register of Controlled Trials (CENTRAL), Google Scholar, and the clinical trial registries (ClinicalTrials.gov), October 2021. RESULTS: Six studies were found, 2 with posterior open reduction and fixation and 4 with cranial-cervical traction, totalizing 197 patients. Neurological worsening was reported only in 1 case (0.5%). CONCLUSIONS: Traumatic disc herniation in cervical facet dislocations is not an absolute contraindication of cranial-cervical traction or posterior open reduction. Early realignment of the spine could bring more neurological benefits than waiting for an MRI or surgical discectomy. However, caution is needed in this review's data interpretation until prospective and well-designed studies are performed.
Authors: A R Vaccaro; L Madigan; M E Schweitzer; A E Flanders; A S Hilibrand; T J Albert Journal: Spine (Phila Pa 1976) Date: 2001-09-01 Impact factor: 3.468
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