Treatment of locked lower cervical fracture and dislocation with anterior cervical fusion and internal fixation combined with the release of interlocking facet through the Luschka joint and anterior lamina space_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 RAO Yaojian ¹ , LI Junjie ² , LIANG Shuhan ² , YANG Lei ¹ , HAN Zhi ¹ , ZHU Bo ¹

1. Department of Spine Surgery, Luoyang Orthopedic-Traumatological Hospital of Henan Province (Henan Provincial Orthopedic Hospital), Luoyang Henan, 471002, P.R.China;
2. Department of Minimally Invasive Spinal Surgery, Hubei 672 Orthopaedic Hospital of Traditional Chinese & Western Medicine, Wuhan Hubei, 430079, P.R.China;

Corresponding?author：

RAO Yaojian, Email: 670570572@qq.com

Keywords：

Locked lower cervical fracture and dislocation; Luschka joint; anterior lamina space; surgical approach

DOI：

10.7507/1002-1892.202006137

Video：

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Objective To investigate the effectiveness of treatment of locked lower cervical fracture and dislocation with anterior cervical fusion and internal fixation combined with the release of the interlocking facet through the Luschka joint and anterior lamina space.Methods Twelve patients with lower cervical interlocking fracture and dislocation were analyzed retrospectively between January 2013 and June 2015. There were 7 males and 5 females, aged 25-59 years with an average age of 38.4 years. The disease duration was 9.6 hours to 100 days with an average of 7.3 days. There were 8 cases of unilateral locking and 4 cases of bilateral locking; 4 cases of old injury and 8 cases of fresh injury. The injured segments were 2 cases of C_{3, 4}, 5 cases of C_{4, 5}, 3 cases of C_{5, 6}, and 2 cases of C_{6, 7}. According to Meyerding classification, there were 9 cases of grade Ⅰ and 3 cases of grade Ⅱ. According to the functional classification of American Spinal Injury Association (ASIA), there were 2 cases of grade C, 6 cases of grade D, and 4 cases of grade E. The interlocking facet was released through the Luschka joint and anterior lamina space, and the anterior cervical fusion and internal fixation were used to treat the fracture and dislocation of the lower cervical spine. The recovery of spinal cord function was judged by the functional classification of ASIA; visual analogue scale (VAS) score, neck disability index (NDI) score, modified Japanese Orthopaedic Association (m-JOA) score were used to evaluate the clinical efficacy; the Cobb angle of fusion segment were observed by X-ray film. The intervertebral bone graft fusion was evaluated at 6 months after operation.Results The average operation time was 78.30 minutes, the average intraoperative blood loss was 167.30 mL, and the average postoperative drainage volume was 58.12 mL. No blood transfusion was given during or after operation. During the operation, there was no accidental injury of large blood vessels, esophagus, and trachea; no laryngo edema, dysphagia, hoarseness, and cerebrospinal fluid leakage occurred after operation; no spinal cord injury or nerve root injury aggravated; the incision healed by first intention, and no infection occurred. All 12 cases were followed up 15-20 months, with an average of 16.5 months. The symptoms and function of the nerve injury were significantly improved when compared with that before operation. Re-examination of the cervical spine X-ray film at 6 months after operation showed that the Cage or bone graft was not displaced or broken, the screw was not loosened or detached, and the intervertebral graft fusion rate was up to 100%. At last follow-up, the ASIA grade, Cobb angle of fusion segment, neck pain VAS score, m-JOA score, and NDI score were significantly improved when compared with preoperative one (P<0.05).Conclusion The effectiveness of treatment of locked lower cervical fracture and dislocation with anterior cervical fusion and internal fixation combined with the release of the interlocking facet through the Luschka joint and anterior lamina space is clear, which not only can make the injured segment get satisfactory reduction, immediate stability and reconstruction, and full decompression, but also can effectively prevent the secondary injury of spinal cord.

Citation： RAO Yaojian, LI Junjie, LIANG Shuhan, YANG Lei, HAN Zhi, ZHU Bo. Treatment of locked lower cervical fracture and dislocation with anterior cervical fusion and internal fixation combined with the release of interlocking facet through the Luschka joint and anterior lamina space. Chinese Journal of Reparative and Reconstructive Surgery, 2021, 35(1): 39-45. doi: 10.7507/1002-1892.202006137 Copy

1.	Anissipour AK, Agel J, Baron M, et al. Traumatic cervical unilateral and bilateral facet dislocations treated with anterior cervical discectomy and fusion has a low failure rate. Global Spine J, 2017, 7(2): 110-115.
2.	Allen BL, Ferguson RL, Lehmann TR, et al. A mechanistic classification of closed, indirect fractures and dislocations of the lower cervical spine. Spine (Phila Pa 1976), 1982, 7(1): 1-27.
3.	Shen Y, Shen HL, Feng ML, et al. Immediate reduction under general anesthesia and single-staged anteroposterior spinal reconstruction for fracture-dislocation of lower cervical spine. J Spinal Disord Tech, 2015, 28(1): E1-8.
4.	賀永雄, 劉斌, 張沛, 等. 頸椎椎弓根釘釘棒內固定系統治療嚴重下頸椎骨折脫位. 中華臨床醫師雜志 (電子版), 2011, 5(8): 2446-2449.
5.	劉加元, 李業成, 劉守正, 等. 聯合入路手術治療下頸椎骨折脫位伴關節突絞鎖. 山東醫藥, 2013, 53(43): 44-45.
6.	徐進, 程建華, 鄭璟, 等. 前路減壓復位融合內固定術治療下頸椎骨折脫位合并脊髓損傷的臨床研究. 創傷外科雜志, 2019, 21(11): 853-856.
7.	汪雷, 宋躍明, 劉浩, 等. 強直性脊柱炎合并下頸椎骨折脫位患者的手術治療. 中國骨與關節雜志, 2014, 33(10): 745-750.
8.	Song KJ, Lee KB. Anterior versus combined anterior and posterior fixation/fusion in the treatment of distraction-flexion injury in the lower cervical spine. J Clin Neurosci, 2008, 15(1): 36-42.
9.	Harms J, Stoltze D. The indication and principle of correction post-traumatic deformities. Eur Spine J, 1992, 1(3): 142-151.
10.	Robertson PA, Ryan MD. Neurological deterioration after reduction of cervical subluxation. Mechanical compression by disc tissue. J Bone Joint Surg (Br), 1992, 74(2): 224-227.
11.	王剛祥, 周海東, 徐宏宇, 等. 單側小關節交鎖的下頸椎骨折脫位的手術療效. 臨床骨科雜志, 2017, 20(3): 279-281.
12.	簡偉, 吳廣森, 隰建成, 等. 顱骨牽引復位配合頸前路減壓融合術治療下頸椎骨折脫位合并關節突絞鎖的臨床研究. 中國醫藥導報, 2019, 16(36): 85-88.
13.	王龍強, 黃相鵬, 付松, 等. 顱骨牽引聯合手法復位并手術治療下頸椎骨折脫位合并關節突交鎖的療效觀察. 中國骨與關節損傷雜志, 2019, 34(5): 488-490.
14.	沈哲, 郭偉壯, 楊欣建. 顱骨牽引復位配合前路減壓融合治療下頸椎骨折脫位伴關節突絞鎖. 實用骨科雜志, 2019, 25(1): 55-58.
15.	康永生, 梅偉, 王慶德, 等. 術中顱骨牽引與撬撥復位治療下頸椎單節段關節突絞鎖. 中國矯形外科雜志, 2017, 25(17): 1606-1610.
16.	周非非, 張一龍, 李舒揚, 等. SF-36 量表用于國人脊髓型頸椎病的信度分析及其與神經功能的相關性研究. 中國脊柱脊髓雜志, 2020, 30(3): 256-262.
17.	鐘睿, 王潤生, 劉建恒, 等. 不同入路微創經椎間孔腰椎間融合術治療單節段腰椎管狹窄癥的療效比較. 中國修復重建外科雜志, 2019, 33(7): 807-813.
18.	Aebi M. Surgical treatment of upper, middle and lower cervical injuries and non-unions by anterior procedures. Eur Spine J, 2010, 19 Suppl 1(Suppl 1): S33-39.
19.	Jain AK, Dhammi IK, Singh AP, et al. Neglected traumatic dislocation of the subaxial cervical spine. J Bone Joint Surg (Br), 2010, 92(2): 246-249.
20.	Miao DC, Zhang BY, Lei T, et al. Clinical efficacy of anterior partial corpectomy and titanium mesh fusion and internal fixation for treatment of old fracture dislocation of the lower cervical spine. Med Sci Monit, 2017, 23: 5675-5682.
21.	陳舉, 張朝春. 全麻下顱骨牽引復位配合頸前路減壓融合治療下頸椎骨折脫位伴關節突交鎖. 第三軍醫大學學報, 2016, 38(1): 93-96.
22.	Ngo LM, Aizawa T, Hoshikawa T, et al. Fracture and contralateral dislocation of the twin facet joints of the lower cervical spine. Eur Spine J, 2012, 21(2): 282-288.
23.	張偉, 楊博貴, 劉愛文. 經前后路聯合椎弓根釘內固定治療 67 例頸椎骨折脫位的療效評價. 中國骨與關節損傷雜志, 2014, 29(7): 645-647.
24.	黃隆, 林其仁, 黃杰苗, 等. 前路手術治療陳舊性下頸椎骨折脫位. 中國骨傷, 2011, 24(9): 785-787.
25.	Jiang X, Cao Y, Yao Y, et al. Surgical management of old lower cervical dislocations with locked facet. Clin Spine Surg, 2016, 29(6): E319-324.
26.	李東方, 周英杰, 史相欽, 等. 平樂正骨手法在下頸椎骨折脫位復位中的作用. 中華中醫藥雜志, 2018, 33(2): 792-794.
27.	黃云飛, 孟羿彬, 賀欣, 等. 單純前路手術治療無脊髓損傷的頸椎骨折脫位伴關節突交鎖. 中華骨與關節外科雜志, 2015, 8(3): 218-223.
28.	Gao W, Wang B, Hao D, et al. Surgical treatment of lower cervical fracture-dislocation with spinal cord injuries by anterior approach: 5- to 15-year follow-up. World Neurosurg, 2018, 115: e137-e145.
29.	劉軍, 李偉偉, 祁潔, 等. 下頸椎骨折合并關節突交鎖的手術策略. 實用骨科雜志, 2018, 24(6): 487-490.
30.	Epstein NE. A review of complication rates for anterior cervical diskectomy and fusion (ACDF). Surg Neurol Int, 2019, 10: 100. doi: 10.25259/SNI-191-2019. eCollection 2019.
31.	Banno F, Zreik J, Alvi MA, et al. Anterior cervical corpectomy and fusion versus anterior cervical discectomy and fusion for treatment of multilevel cervical spondylotic myelopathy: insights from a national registry. World Neurosurg, 2019, 132: e852-e861.
32.	Hong JT, Kim IS, Kim JY, et al. Risk factor analysis and decision-making of surgical strategy for V3 segment anomaly: significance of preoperative CT angiography for posterior C₁ instrumentation. Spine J, 2016, 16(9): 1055-1061.
33.	Bruneau M, Cornelius JF, Marneffe V, et al. Anatomical variationsof the V2 segment of the vertebral artery. Neurosurgery, 2006, 59(1Suppl 1): ONS20-24.
34.	朱彥昭, 徐榮明, 馬維虎. 頸椎手術中椎動脈損傷的研究進展. 中醫正骨, 2010, 22(9): 28-31.
35.	孔抗美, 齊偉力, 王衛東, 等. 頸神經根管切開減壓術的應用解剖研究. 中華骨科雜志, 1997, 17(8): 479-481.
36.	程云飛, 楊凌洪, 石恩金. 頸神經根槽和頸椎間孔的應用解剖. 解剖科學進展, 2002, 8(2): 183-184.

1. Anissipour AK, Agel J, Baron M, et al. Traumatic cervical unilateral and bilateral facet dislocations treated with anterior cervical discectomy and fusion has a low failure rate. Global Spine J, 2017, 7(2): 110-115.
2. Allen BL, Ferguson RL, Lehmann TR, et al. A mechanistic classification of closed, indirect fractures and dislocations of the lower cervical spine. Spine (Phila Pa 1976), 1982, 7(1): 1-27.
3. Shen Y, Shen HL, Feng ML, et al. Immediate reduction under general anesthesia and single-staged anteroposterior spinal reconstruction for fracture-dislocation of lower cervical spine. J Spinal Disord Tech, 2015, 28(1): E1-8.
4. 賀永雄, 劉斌, 張沛, 等. 頸椎椎弓根釘釘棒內固定系統治療嚴重下頸椎骨折脫位. 中華臨床醫師雜志 (電子版), 2011, 5(8): 2446-2449.
5. 劉加元, 李業成, 劉守正, 等. 聯合入路手術治療下頸椎骨折脫位伴關節突絞鎖. 山東醫藥, 2013, 53(43): 44-45.
6. 徐進, 程建華, 鄭璟, 等. 前路減壓復位融合內固定術治療下頸椎骨折脫位合并脊髓損傷的臨床研究. 創傷外科雜志, 2019, 21(11): 853-856.
7. 汪雷, 宋躍明, 劉浩, 等. 強直性脊柱炎合并下頸椎骨折脫位患者的手術治療. 中國骨與關節雜志, 2014, 33(10): 745-750.
8. Song KJ, Lee KB. Anterior versus combined anterior and posterior fixation/fusion in the treatment of distraction-flexion injury in the lower cervical spine. J Clin Neurosci, 2008, 15(1): 36-42.
9. Harms J, Stoltze D. The indication and principle of correction post-traumatic deformities. Eur Spine J, 1992, 1(3): 142-151.
10. Robertson PA, Ryan MD. Neurological deterioration after reduction of cervical subluxation. Mechanical compression by disc tissue. J Bone Joint Surg (Br), 1992, 74(2): 224-227.
11. 王剛祥, 周海東, 徐宏宇, 等. 單側小關節交鎖的下頸椎骨折脫位的手術療效. 臨床骨科雜志, 2017, 20(3): 279-281.
12. 簡偉, 吳廣森, 隰建成, 等. 顱骨牽引復位配合頸前路減壓融合術治療下頸椎骨折脫位合并關節突絞鎖的臨床研究. 中國醫藥導報, 2019, 16(36): 85-88.
13. 王龍強, 黃相鵬, 付松, 等. 顱骨牽引聯合手法復位并手術治療下頸椎骨折脫位合并關節突交鎖的療效觀察. 中國骨與關節損傷雜志, 2019, 34(5): 488-490.
14. 沈哲, 郭偉壯, 楊欣建. 顱骨牽引復位配合前路減壓融合治療下頸椎骨折脫位伴關節突絞鎖. 實用骨科雜志, 2019, 25(1): 55-58.
15. 康永生, 梅偉, 王慶德, 等. 術中顱骨牽引與撬撥復位治療下頸椎單節段關節突絞鎖. 中國矯形外科雜志, 2017, 25(17): 1606-1610.
16. 周非非, 張一龍, 李舒揚, 等. SF-36 量表用于國人脊髓型頸椎病的信度分析及其與神經功能的相關性研究. 中國脊柱脊髓雜志, 2020, 30(3): 256-262.
17. 鐘睿, 王潤生, 劉建恒, 等. 不同入路微創經椎間孔腰椎間融合術治療單節段腰椎管狹窄癥的療效比較. 中國修復重建外科雜志, 2019, 33(7): 807-813.
18. Aebi M. Surgical treatment of upper, middle and lower cervical injuries and non-unions by anterior procedures. Eur Spine J, 2010, 19 Suppl 1(Suppl 1): S33-39.
19. Jain AK, Dhammi IK, Singh AP, et al. Neglected traumatic dislocation of the subaxial cervical spine. J Bone Joint Surg (Br), 2010, 92(2): 246-249.
20. Miao DC, Zhang BY, Lei T, et al. Clinical efficacy of anterior partial corpectomy and titanium mesh fusion and internal fixation for treatment of old fracture dislocation of the lower cervical spine. Med Sci Monit, 2017, 23: 5675-5682.
21. 陳舉, 張朝春. 全麻下顱骨牽引復位配合頸前路減壓融合治療下頸椎骨折脫位伴關節突交鎖. 第三軍醫大學學報, 2016, 38(1): 93-96.
22. Ngo LM, Aizawa T, Hoshikawa T, et al. Fracture and contralateral dislocation of the twin facet joints of the lower cervical spine. Eur Spine J, 2012, 21(2): 282-288.
23. 張偉, 楊博貴, 劉愛文. 經前后路聯合椎弓根釘內固定治療 67 例頸椎骨折脫位的療效評價. 中國骨與關節損傷雜志, 2014, 29(7): 645-647.
24. 黃隆, 林其仁, 黃杰苗, 等. 前路手術治療陳舊性下頸椎骨折脫位. 中國骨傷, 2011, 24(9): 785-787.
25. Jiang X, Cao Y, Yao Y, et al. Surgical management of old lower cervical dislocations with locked facet. Clin Spine Surg, 2016, 29(6): E319-324.
26. 李東方, 周英杰, 史相欽, 等. 平樂正骨手法在下頸椎骨折脫位復位中的作用. 中華中醫藥雜志, 2018, 33(2): 792-794.
27. 黃云飛, 孟羿彬, 賀欣, 等. 單純前路手術治療無脊髓損傷的頸椎骨折脫位伴關節突交鎖. 中華骨與關節外科雜志, 2015, 8(3): 218-223.
28. Gao W, Wang B, Hao D, et al. Surgical treatment of lower cervical fracture-dislocation with spinal cord injuries by anterior approach: 5- to 15-year follow-up. World Neurosurg, 2018, 115: e137-e145.
29. 劉軍, 李偉偉, 祁潔, 等. 下頸椎骨折合并關節突交鎖的手術策略. 實用骨科雜志, 2018, 24(6): 487-490.
30. Epstein NE. A review of complication rates for anterior cervical diskectomy and fusion (ACDF). Surg Neurol Int, 2019, 10: 100. doi: 10.25259/SNI-191-2019. eCollection 2019.
31. Banno F, Zreik J, Alvi MA, et al. Anterior cervical corpectomy and fusion versus anterior cervical discectomy and fusion for treatment of multilevel cervical spondylotic myelopathy: insights from a national registry. World Neurosurg, 2019, 132: e852-e861.
32. Hong JT, Kim IS, Kim JY, et al. Risk factor analysis and decision-making of surgical strategy for V3 segment anomaly: significance of preoperative CT angiography for posterior C₁ instrumentation. Spine J, 2016, 16(9): 1055-1061.
33. Bruneau M, Cornelius JF, Marneffe V, et al. Anatomical variationsof the V2 segment of the vertebral artery. Neurosurgery, 2006, 59(1Suppl 1): ONS20-24.
34. 朱彥昭, 徐榮明, 馬維虎. 頸椎手術中椎動脈損傷的研究進展. 中醫正骨, 2010, 22(9): 28-31.
35. 孔抗美, 齊偉力, 王衛東, 等. 頸神經根管切開減壓術的應用解剖研究. 中華骨科雜志, 1997, 17(8): 479-481.
36. 程云飛, 楊凌洪, 石恩金. 頸神經根槽和頸椎間孔的應用解剖. 解剖科學進展, 2002, 8(2): 183-184.

Chinese Journal of Reparative and Reconstructive Surgery

Treatment of locked lower cervical fracture and dislocation with anterior cervical fusion and internal fixation combined with the release of interlocking facet through the Luschka joint and anterior lamina space

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