Comparison of a novel anterior-only approach and the conventional posterior-anterior approach for cervical facet dislocation: a retrospective study.

Abstract

The surgical treatment of lower cervical facet dislocation is controversial. The objective of this study was to compare the surgical trauma and clinical results of a novel anterior-only approach and with those of the conventional posterior-anterior approach to obtain an optimal method to treat lower cervical facet dislocation. From January 2012 to December 2017, 93 patients with lower cervical facet dislocations were enrolled in the study and divided into two groups as follows: 63 conventional patients who enrolled between January 2014 and December 2017 were included in the anterior-only approach group, and 30 conventional patients who enrolled between January 2012 and December 2013 were included in the posterior-anterior approach group. For the anterior-only approach group, two reduction techniques, including Caspar pins kyphotic paramedian distraction and anterior facetectomy, were used in sequence if the former technique failed. The parameters were as follows: the operation time, the intraoperative blood loss, the number of fixed segments, the fusion rate, and the improvement in the ASIA grade and JOA score. All patients in the anterior-only approach group were successfully reduced by the two techniques. The mean operation time in the posterior-anterior approach group (274.0 ± 114.7 min) was significantly longer than that in the anterior-only approach group (88.6 ± 35.0 min) (p = 0.000). The mean blood loss during the surgery and the number of fixed segments in the posterior-anterior approach group (275.0 ± 183.2 ml; 1.4 ± 0.7, respectively) were significantly greater than those in the anterior-only approach group (92.5 ± 84.0 ml, p = 0.000; 1.2 ± 0.5, p = 0.030, respectively). A 100% fusion rate was observed in both groups after 12-month follow-up. There were no significant differences between the two groups regarding the improvement in the ASIA grade (p = 0.900) or JOA score (p = 0.717). Compared with the conventional posterior-anterior approach, the novel anterior-only approach with two reduction techniques, including Caspar pins kyphotic paramedian distraction and anterior facetectomy, achieved a 100% reduction success rate and induced less surgical trauma, indicating that this method can be recommended as an alternative for lower cervical facet dislocation. These slides can be retrieved under Electronic Supplementary Material.