Surgical approaches in advanced cervical trauma

Background: Bilateral cervical facet dislocations present with severe neurological deficit and an unstable spine. Cervical dislocations with locked facets account for more than 50% of all cervical injuries. The rapid reduction should give the patient the best chance for neurological recovery from compression of the spinal cord or nerve root, or at least prevent progressive secondary spinal cord injury, however, the proper method for reduction and operation is still controversial. Purpose: To evaluate the surgical outcome in cervical spine injury with bilateral facet dislocation. Patients and Methods: In this study, all the records of sixteen patients with cervical bilateral facet dislocations were reviewed. The SLIC scoring was used for surgical decisions. These cases were managed in our department by open reduction and internal fixation from Jan 2018 to March 2020. Clinically we used the Frankel scale to evaluate our patients. Of our 16 patients, nine cases were managed by the anterior approach; four cases were managed by the posterior approach. And three cases needed a combined approach. Results: Mean age was 38 years. A road traffic accident was the cause of 80%. One patient had no neurological deficit. C5/6 and C 6/7 were the commonest injured segments (80%). Disc compression was present in 58% (eleven patients) of cases. The mean SLIC score was 8 and the mean hospital stay was 15 days. Restoring spinal alignment and reduction of facets was achieved in 87.5% (fourteen patients) of patients. Conclusion: Bilateral facet dislocation is a serious sequel to cervical spine trauma. It can present with the entire spectrum of neurological deficits. Patients with incomplete spinal cord injury show improvement after early decompression and fixation.