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Anterior Decompression and Nonstructural Bone Grafting and Posterior Fixation for Cervical Facet Dislocation With Traumatic Disc Herniation

Study Design. A series study of patients with lower cervical facet dislocation accompanied by traumatic disc herniation treated with anterior decompression and nonstructural bone grafting and posterior fixation. Objective. To describe a surgical technique of anterior decompression and nonstructural bone grafting and posterior fixation and its clinical outcome in a group of patients with lower cervical facet dislocation accompanied by traumatic disc herniation. Summary of Background Data. The optimal treatment for lower cervical facet dislocation with a prolapsed disc is still controversial. Methods. After discectomy and endplate preparation, a layer of morselized cancellous bone grafts from the iliac crest was placed in the interspace, and held in appropriate sagittal position by 2 layers of gelatin sponge and carefully sutured longus colli muscle. The anterior wound was then closed. The posterior elements were exposed and the reduction was performed. Fluoroscopy was used during reduction maneuver to ensure that the graft was still in the appropriate position. A posterior fusion was performed and the posterior wound was closed. Results. Between January 2006 and February 2010, 21 patients with cervical facet dislocation accompanied by traumatic disc herniation (13 unilateral dislocations and 8 bilateral dislocations) were recruited for this study. All the patients completed at least 1-year follow-up. Average follow-up duration was 29 ± 3.5 months. Average Frankel scales were significantly improved at the end of follow-up, visual analogue scale decreased from 7.8 ± 1.2 before the operation to less than 1.6 ± 0.5 (P < 0.05) 6 months later. Kyposis was corrected from 17.7° ± 6.3° to 6.5° ± 4.1° (P < 0.05) and remained at 5.9° ± 4.2° (P > 0.05) 1 year later. The average subsidence of bone graft was 1.28 ± 0.16 mm at 12 months after the operation and remained 1.34 ± 0.20 mm at 36 months after the operation. All patients had consolidation of both anterior and posterior fusions. No cases of instrument failure occurred and no complications were attributed to the use of this technique. Conclusion. Although further study based on injury types as well as long-term follow-up is still needed, anterior decompression and nonstructural bone grafting and posterior fixation provides a promising surgical option for treating cervical facet dislocation with traumatic disc herniation.