Efficacy Of Combined Anterior-posterior Reduction And Internal Fixation For The Treatment Of Lower Cervical Facet Dislocation Combined With Spinal Cord Injury

Purpose : To explore the surgical method, safety and efficacy of combined anterior-posterior reduction and internal fixation for the treatment of lower cervical facet dislocation combined with spinal cord injury.Methods : 15 cases of lower cervical facet dislocation with spinal cord injury were treated with combined anterior-posterior reduction and internal fixation, anterior operation first and posterior fixation then. The preoperative and postoperative Frankel grade and Japanese Orthopaedic Association(JOA) score were collected and compared. We calculated the recovery rate of postoperation by JOA score, compared the preoperative and postoperative Cobb’s angle, and observed the condition of osseous fusion.Results : There are 1 case of hoarse and deglutitive difficulty, in the process of follow-up all symptoms disappeared. There are 1 case of hyponatremia, cured after repaired. All patients were followed up for 6 months to 3 years(average 15.6 months). All cervical facet dislocation were reset after the operation by the postoperative X-ray or CT, and no broken, looseing or sinking of implant. The Frankel grade was improved obviously and the average of 1.33 grade was increased. There was a significant improvement of JOA score(P<0.05), preoperative JOA score was 6.9±3.4, which increased to 13.1±4.2 at the end of follow-up. The recovery rate related to JOA score was 66.2%±22.2%. Preoperative Cobb’s angle was-6.2°±4.0°, which increased to 5.6°±2.3° immediately after surgery and around 6.5°±1.9° at the end of follow-up. There was statistically significant difference between preoperative and postoperative(P<0.05), while no significant difference was found between postoperative and follow-up(P>0.05). During postoperative follow-up period, the conditions of bone graft fusions were satisfied.Conclusion Combined anterior-posterior reduction and internal fixation is an effective method for the treatment of lower cervical facet dislocation combined with spinal cord injury.(1)This surgery restores the normal physiological curvature of cervical spine;(2)The spine cord function gets coverage, and the conditions of bone graft fusions were satisfied;(3)Combined anterior-posterior way provide more stable method than the anterior or posterior way;(4)It is a safe surgery and avoid complicated anterior-posterior-anterior operation, reduce surgical trauma and risk.