Treatment of traumatic spondylolisthesis of the lower cervical spine with concomitant bilateral facet dislocations: Risk of respiratory deterioration

Abstract Background This study aimed to retrospectively examine 36 cases of bilateral cervical facet dislocations (BCFD) of the lower cervical spine who were at risk for respiratory deterioration. Methods The cases of 36 subjects with BCFD of the lower cervical spine who failed to achieve closed red...

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Bibliographic Details
Published in:Clinical neurology and neurosurgery 2014-08, Vol.123, p.96-101
Main Authors: Ye, Zhe-Wei, Yang, Shu-Hua, Chen, Bao-Jun, Xiong, Li-Ming, Xu, Jian-Zhong, He, Qing-Yi
Format: Article
Language:English
Subjects:
Adolescent
Adult
Aged
Aged, 80 and over
Cervical facet dislocations
Female
Hospitals
Humans
Infections
Intubation
Joint Dislocations - complications
Joint Dislocations - surgery
Male
Middle Aged
Neurology
Neurosurgery
NMR
Nuclear magnetic resonance
Posterior approach
Respiratory deterioration
Respiratory distress syndrome
Respiratory Insufficiency - etiology
Retrospective Studies
Risk
Risk Assessment
Spinal cord injuries
Spinal Fusion - methods
Spinal Injuries - surgery
Spondylolisthesis - complications
Spondylolisthesis - surgery
Tomography
Treatment Outcome
Ventilation
Young Adult
Zygapophyseal Joint
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Summary:Abstract Background This study aimed to retrospectively examine 36 cases of bilateral cervical facet dislocations (BCFD) of the lower cervical spine who were at risk for respiratory deterioration. Methods The cases of 36 subjects with BCFD of the lower cervical spine who failed to achieve closed reduction were retrospectively studied. The extents of neurological injuries included posterior neck pain without neurological deficit ( n = 2), incomplete spinal cord injury (ISCI) ( n = 21), and complete spinal cord injury (CSCI) ( n = 13). Results Among the subjects, 26 (72.22%) had dyspnea, 6 required mechanical ventilation due to respiratory muscle paralysis, 11 required tracheostomy, and 9 required intubation. All patients received posterior approach reduction, stabilization, and fusion treatment for BCFD in one operative session. For the 26 quadriparetic patients with dyspnea, priority was given to treating their respiratory problems. For the other 10 patients without dyspnea, surgical treatment for irreducible lower cervical spine dislocation was given priority. After an average follow-up period of 63 months, 21 complications were found, but all patients exhibited fusion. Twenty-one patients with ISCI exhibited improvements in their conditions of 1 or 2 grades on the American Spinal Injury Association scale, whereas those with CSCI did not improve. All 26 apnea cases improved. The majority (26) of the 36 cases with BCFD of the lower cervical spine suffered dyspnea. Conclusions Although further study is required, our study suggests that the posterior surgical approach to the cervical spine is safe and effective for patients with traumatic spondylolisthesis of the lower cervical spine concomitant with BCFD who are at risk of respiratory deterioration.
ISSN:0303-8467
1872-6968
DOI:10.1016/j.clineuro.2014.04.010