Surgical management protocol for anterior-only reduction and fixation for acute, delayed and old subaxial cervical facet dislocation: a retrospective study of 87 consecutive cases in China.

Abstract

Retrospective study. To evaluate the efficacy of a surgical protocol utilizing novel anterior-only reduction and fixation techniques for acute, delayed, and old subaxial cervical facet dislocations. There is no clear consensus on the optimal surgical approach (anterior, posterior, or combined) for cervical facet dislocation. Over a 10-year period, 87 consecutive patients with subaxial cervical facet dislocations were treated using an anterior-only approach. Patients were classified into three groups: (1) those indicated for urgent surgery; (2) those contraindicated for urgent surgery; and (3) those with old dislocations. Closed reduction was used in patients contraindicated for urgent surgery. Open reduction involved two anterior-only reduction techniques: modified Caspar pin kyphotic paramedian distraction and anterior facetectomy if required. Fixation was performed with anterior vertebral screw plates for C3/4, C4/5, and selected C5/6 cases, or pedicle screw plates for C6/7, C7/ T1, and C5/6 cases with severe vertebral or articular process fractures. Reduction success rates were 67% for closed reduction, 81% for the modified Caspar pin kyphotic paramedian distraction, and 100% for anterior facetectomy. No supplemental posterior surgery was required. At a minimum follow-up of 12 months, all patients achieved satisfactory fusion without implant failure. Neurological improvement of at least one American Spinal Injury Association grade was observed in 29 patients (43.9%), and no neurological deterioration occurred. The anterior-only protocol, incorporating modified kyphotic paramedian distraction with Caspar pins, anterior facetectomy, and anterior pedicle screw plate fixation, is safe and effective for managing acute, delayed, and old subaxial cervical facet dislocations.