Facet Dislocation Fractures of Subaxial Cervical Spine: A Treatment Algorithm for Surgical Approach Decision

CAN, SONGUL MELTEM; Yilmaz, Adem; Ozoner, Baris; Aydin, Levent; Müslüman, Ahmet Murat

doi:10.4274/BMB.galenos.2020.06.2

Facet Dislocation Fractures of Subaxial Cervical Spine: A Treatment Algorithm for Surgical Approach Decision

Barış ÖZÖNER, (Bahçeşehir Üniversitesi, Tıp Fakültesi, Nöroşirurji Anabilim Dalı, İstanbul, Türkiye)

Levent AYDIN, (Sağlık Bilimleri Üniversitesi, Şişli Etfal Eğitim ve Araştırma Hastanesi, Nöroşirürji Kliniği, İstanbul, Türkiye)

Songül Meltem CAN, (Sağlık Bilimleri Üniversitesi, Şişli Etfal Eğitim ve Araştırma Hastanesi, Nöroşirurji Kliniği, İstanbul, Türkiye)

Ahmet Murat MÜSLÜMAN, (Sağlık Bilimleri Üniversitesi, Şişli Etfal Eğitim ve Araştırma Hastanesi, Nöroşirurji Kliniği, İstanbul, Türkiye)

Adem YILMAZ (Sağlık Bilimleri Üniversitesi, Şişli Etfal Eğitim ve Araştırma Hastanesi, Nöroşirurji Kliniği, İstanbul, Türkiye)

Bağcılar Tıp Bülteni

4 0

Yıl: 2020 Cilt: 5 Sayı: 3 Sayfa Aralığı: 123 - 132 Metin Dili: İngilizce DOI: 10.4274/BMB.galenos.2020.06.2 İndeks Tarihi: 30-04-2021

Facet Dislocation Fractures of Subaxial Cervical Spine: A Treatment Algorithm for Surgical Approach Decision

Öz:

Objective: To perform an analysis of the surgical approach choice in subaxial cervical spine (SCS) facet dislocations.Method: The inclusion criteria were as follows: radiologically confirmed traumatic SCS facet dislocation, 18-70 years of age, stable medical condition, and isolated cervical trauma. The management scheme was based on the presence of traumatic disc herniation (TDH) and the grade of dislocation according to the Allen and Ferguson classification (AFC). In the absence of TDH, the reduction was attempted via traction under general anesthesia before surgery. In the presence of TDH, the reduction wasattemptedafteranteriordiscectomy.Posterioropenreductionwas performed in case of an unsuccessful reduction attempt. Anterior stabilization was sufficient in AFC distractive flexion stage (DFS) 2 fractures while combined stabilization was performed in DFS 3 and 4 fractures. Results: Thirty-two patients were included in the study. TDH was detected in 14 patients. The number of patients with DFS 2, 3, and 4 fractures was 6, 18, and 8, respectively. Posterior open reduction was needed in 9 patients. Anterior stabilization was performed in 6 patients (3 with TDH, 3 without TDH) and combined stabilization was performed in 26 patients (11 with TDH, 15 without TDH) via 6 anterior, 7 anterior-posterior, 15 posterior-anterior, and 4 anterior-posterior-anterior approaches. Satisfactory follow-up results were achieved in radiological and neurological evaluations, and neck pain scores. Conclusion: The treatment algorithm for subaxial facet dislocations based on DFS and TDH presence provided satisfactory results.Keywords: Allen and Ferguson classification, decision-making, facet dislocation fracture, subaxial cervical spine, subaxial injury classification and Severity scale, traumatic disc herniation

Anahtar Kelime:

Subaksiyel Servikal Omurganın Faset Dislokasyon Fraktürleri: Cerrahi Yaklaşım Kararı için Tedavi Algoritması

Öz:

Amaç: Bu çalışmada subaksiyel servikal omurga (SSO) faset dislokasyon fraktürlerinde cerrahi yaklaşım seçimi algoritması geliştirilmesi amaçlanmıştır. Yöntem: Çalışmaya dahil edilme kriterleri şu şekildeydi: Radyolojik olarak gösterilmiş travmatik SSO faset dislokasyon fraktürü, 18-70 yaş, medikal olarak stabil durum ve izole servikal travma varlığı. Tedavi algoritması temel olarak, travmatik disk herniasyonu (TDH) varlığına ve Allen ve Ferguson sınıflamasına (AFS) göre dislokasyon derecesine göre düzenlenmekteydi. Radyolojik incelemelerde TDH saptanmazsa, cerrahi girişim öncesinde genel anestezi altında traksiyon ile redüksiyon denenmesi yapılmaktaydı. TDH varlığında ise traksiyon denemesi öncesinde anterior diskektomi yapılmaktaydı. Eğer traksiyon ile redüksiyon girişimi başarısız olursa, posterioraçıkredüksiyonyapılmaktaydı.AFS’sinegöredistraktivefleksiyon evre (DFE) 2 fraktürlerinde anterior stabilizasyon uygulanırken, DFE 3 ve 4 dislokasyonlarda kombine stabilizasyon yapılmaktaydı. Bulgular: Çalışmaya 32 hasta dahil edildi. On dört hastada radyolojik incelemelerde TDH saptandı. Altı hastada DFE 2, 18 hastada DFE 3 ve 8 hastada DFE 4 faset dislokasyon fraktürü mevcut idi. Posterior açık redüksiyon 9 hastada gerekli oldu. Altı hastaya (3 TDH’si olan, 3 TDH’si olmayan) anterior stabilizasyon ve 26 hastaya (11 TDH’si olan, 15 TDH’si olmayan) kombine stabilizasyon uygulandı. Altı anterior, 7 anterior-posterior, 15 posterior-anterior ve 4 anterior-posterior-anterior yaklaşım uygulandı.Radyolojik,nörolojikdeğerlendirmelerdeveboyunağrısıskorlarında tatmin edici sonuçlar elde edildi. Sonuç:DFEveTDHvarlığınagöreoluşturulansubaksiyelfasetdislokasyonları için cerrahi tedavi algoritması ile başarılı sonuçlar elde edilmiştir.

Anahtar Kelime:

Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık

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APA	Ozoner B, Aydin L, CAN S, Müslüman A, Yilmaz A (2020). Facet Dislocation Fractures of Subaxial Cervical Spine: A Treatment Algorithm for Surgical Approach Decision. , 123 - 132. 10.4274/BMB.galenos.2020.06.2
Chicago	Ozoner Baris,Aydin Levent,CAN SONGUL MELTEM,Müslüman Ahmet Murat,Yilmaz Adem Facet Dislocation Fractures of Subaxial Cervical Spine: A Treatment Algorithm for Surgical Approach Decision. (2020): 123 - 132. 10.4274/BMB.galenos.2020.06.2
MLA	Ozoner Baris,Aydin Levent,CAN SONGUL MELTEM,Müslüman Ahmet Murat,Yilmaz Adem Facet Dislocation Fractures of Subaxial Cervical Spine: A Treatment Algorithm for Surgical Approach Decision. , 2020, ss.123 - 132. 10.4274/BMB.galenos.2020.06.2
AMA	Ozoner B,Aydin L,CAN S,Müslüman A,Yilmaz A Facet Dislocation Fractures of Subaxial Cervical Spine: A Treatment Algorithm for Surgical Approach Decision. . 2020; 123 - 132. 10.4274/BMB.galenos.2020.06.2
Vancouver	Ozoner B,Aydin L,CAN S,Müslüman A,Yilmaz A Facet Dislocation Fractures of Subaxial Cervical Spine: A Treatment Algorithm for Surgical Approach Decision. . 2020; 123 - 132. 10.4274/BMB.galenos.2020.06.2
IEEE	Ozoner B,Aydin L,CAN S,Müslüman A,Yilmaz A "Facet Dislocation Fractures of Subaxial Cervical Spine: A Treatment Algorithm for Surgical Approach Decision." , ss.123 - 132, 2020. 10.4274/BMB.galenos.2020.06.2
ISNAD	Ozoner, Baris vd. "Facet Dislocation Fractures of Subaxial Cervical Spine: A Treatment Algorithm for Surgical Approach Decision". (2020), 123-132. https://doi.org/10.4274/BMB.galenos.2020.06.2

APA	Ozoner B, Aydin L, CAN S, Müslüman A, Yilmaz A (2020). Facet Dislocation Fractures of Subaxial Cervical Spine: A Treatment Algorithm for Surgical Approach Decision. Bağcılar Tıp Bülteni, 5(3), 123 - 132. 10.4274/BMB.galenos.2020.06.2
Chicago	Ozoner Baris,Aydin Levent,CAN SONGUL MELTEM,Müslüman Ahmet Murat,Yilmaz Adem Facet Dislocation Fractures of Subaxial Cervical Spine: A Treatment Algorithm for Surgical Approach Decision. Bağcılar Tıp Bülteni 5, no.3 (2020): 123 - 132. 10.4274/BMB.galenos.2020.06.2
MLA	Ozoner Baris,Aydin Levent,CAN SONGUL MELTEM,Müslüman Ahmet Murat,Yilmaz Adem Facet Dislocation Fractures of Subaxial Cervical Spine: A Treatment Algorithm for Surgical Approach Decision. Bağcılar Tıp Bülteni, vol.5, no.3, 2020, ss.123 - 132. 10.4274/BMB.galenos.2020.06.2
AMA	Ozoner B,Aydin L,CAN S,Müslüman A,Yilmaz A Facet Dislocation Fractures of Subaxial Cervical Spine: A Treatment Algorithm for Surgical Approach Decision. Bağcılar Tıp Bülteni. 2020; 5(3): 123 - 132. 10.4274/BMB.galenos.2020.06.2
Vancouver	Ozoner B,Aydin L,CAN S,Müslüman A,Yilmaz A Facet Dislocation Fractures of Subaxial Cervical Spine: A Treatment Algorithm for Surgical Approach Decision. Bağcılar Tıp Bülteni. 2020; 5(3): 123 - 132. 10.4274/BMB.galenos.2020.06.2
IEEE	Ozoner B,Aydin L,CAN S,Müslüman A,Yilmaz A "Facet Dislocation Fractures of Subaxial Cervical Spine: A Treatment Algorithm for Surgical Approach Decision." Bağcılar Tıp Bülteni, 5, ss.123 - 132, 2020. 10.4274/BMB.galenos.2020.06.2
ISNAD	Ozoner, Baris vd. "Facet Dislocation Fractures of Subaxial Cervical Spine: A Treatment Algorithm for Surgical Approach Decision". Bağcılar Tıp Bülteni 5/3 (2020), 123-132. https://doi.org/10.4274/BMB.galenos.2020.06.2