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.	贺永雄, 刘斌, 张沛, 等. 颈椎椎弓根钉钉棒内固定系统治疗严重下颈椎骨折脱位. 中华临床医师杂志 (电子版), 2011, 5(8): 2446-2449.
5.	刘加元, 李业成, 刘守正, 等. 联合入路手术治疗下颈椎骨折脱位伴关节突绞锁. 山东医药, 2013, 53(43): 44-45.
6.	徐进, 程建华, 郑璟, 等. 前路减压复位融合内固定术治疗下颈椎骨折脱位合并脊髓损伤的临床研究. 创伤外科杂志, 2019, 21(11): 853-856.
7.	汪雷, 宋跃明, 刘浩, 等. 强直性脊柱炎合并下颈椎骨折脱位患者的手术治疗. 中国骨与关节杂志, 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.	王刚祥, 周海东, 徐宏宇, 等. 单侧小关节交锁的下颈椎骨折脱位的手术疗效. 临床骨科杂志, 2017, 20(3): 279-281.
12.	简伟, 吴广森, 隰建成, 等. 颅骨牵引复位配合颈前路减压融合术治疗下颈椎骨折脱位合并关节突绞锁的临床研究. 中国医药导报, 2019, 16(36): 85-88.
13.	王龙强, 黄相鹏, 付松, 等. 颅骨牵引联合手法复位并手术治疗下颈椎骨折脱位合并关节突交锁的疗效观察. 中国骨与关节损伤杂志, 2019, 34(5): 488-490.
14.	沈哲, 郭伟壮, 杨欣建. 颅骨牵引复位配合前路减压融合治疗下颈椎骨折脱位伴关节突绞锁. 实用骨科杂志, 2019, 25(1): 55-58.
15.	康永生, 梅伟, 王庆德, 等. 术中颅骨牵引与撬拨复位治疗下颈椎单节段关节突绞锁. 中国矫形外科杂志, 2017, 25(17): 1606-1610.
16.	周非非, 张一龙, 李舒扬, 等. SF-36 量表用于国人脊髓型颈椎病的信度分析及其与神经功能的相关性研究. 中国脊柱脊髓杂志, 2020, 30(3): 256-262.
17.	钟睿, 王润生, 刘建恒, 等. 不同入路微创经椎间孔腰椎间融合术治疗单节段腰椎管狭窄症的疗效比较. 中国修复重建外科杂志, 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.	陈举, 张朝春. 全麻下颅骨牵引复位配合颈前路减压融合治疗下颈椎骨折脱位伴关节突交锁. 第三军医大学学报, 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.	张伟, 杨博贵, 刘爱文. 经前后路联合椎弓根钉内固定治疗 67 例颈椎骨折脱位的疗效评价. 中国骨与关节损伤杂志, 2014, 29(7): 645-647.
24.	黄隆, 林其仁, 黄杰苗, 等. 前路手术治疗陈旧性下颈椎骨折脱位. 中国骨伤, 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.	李东方, 周英杰, 史相钦, 等. 平乐正骨手法在下颈椎骨折脱位复位中的作用. 中华中医药杂志, 2018, 33(2): 792-794.
27.	黄云飞, 孟羿彬, 贺欣, 等. 单纯前路手术治疗无脊髓损伤的颈椎骨折脱位伴关节突交锁. 中华骨与关节外科杂志, 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.	刘军, 李伟伟, 祁洁, 等. 下颈椎骨折合并关节突交锁的手术策略. 实用骨科杂志, 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.	朱彦昭, 徐荣明, 马维虎. 颈椎手术中椎动脉损伤的研究进展. 中医正骨, 2010, 22(9): 28-31.
35.	孔抗美, 齐伟力, 王卫东, 等. 颈神经根管切开减压术的应用解剖研究. 中华骨科杂志, 1997, 17(8): 479-481.
36.	程云飞, 杨凌洪, 石恩金. 颈神经根槽和颈椎间孔的应用解剖. 解剖科学进展, 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. 贺永雄, 刘斌, 张沛, 等. 颈椎椎弓根钉钉棒内固定系统治疗严重下颈椎骨折脱位. 中华临床医师杂志 (电子版), 2011, 5(8): 2446-2449.
5. 刘加元, 李业成, 刘守正, 等. 联合入路手术治疗下颈椎骨折脱位伴关节突绞锁. 山东医药, 2013, 53(43): 44-45.
6. 徐进, 程建华, 郑璟, 等. 前路减压复位融合内固定术治疗下颈椎骨折脱位合并脊髓损伤的临床研究. 创伤外科杂志, 2019, 21(11): 853-856.
7. 汪雷, 宋跃明, 刘浩, 等. 强直性脊柱炎合并下颈椎骨折脱位患者的手术治疗. 中国骨与关节杂志, 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. 王刚祥, 周海东, 徐宏宇, 等. 单侧小关节交锁的下颈椎骨折脱位的手术疗效. 临床骨科杂志, 2017, 20(3): 279-281.
12. 简伟, 吴广森, 隰建成, 等. 颅骨牵引复位配合颈前路减压融合术治疗下颈椎骨折脱位合并关节突绞锁的临床研究. 中国医药导报, 2019, 16(36): 85-88.
13. 王龙强, 黄相鹏, 付松, 等. 颅骨牵引联合手法复位并手术治疗下颈椎骨折脱位合并关节突交锁的疗效观察. 中国骨与关节损伤杂志, 2019, 34(5): 488-490.
14. 沈哲, 郭伟壮, 杨欣建. 颅骨牵引复位配合前路减压融合治疗下颈椎骨折脱位伴关节突绞锁. 实用骨科杂志, 2019, 25(1): 55-58.
15. 康永生, 梅伟, 王庆德, 等. 术中颅骨牵引与撬拨复位治疗下颈椎单节段关节突绞锁. 中国矫形外科杂志, 2017, 25(17): 1606-1610.
16. 周非非, 张一龙, 李舒扬, 等. SF-36 量表用于国人脊髓型颈椎病的信度分析及其与神经功能的相关性研究. 中国脊柱脊髓杂志, 2020, 30(3): 256-262.
17. 钟睿, 王润生, 刘建恒, 等. 不同入路微创经椎间孔腰椎间融合术治疗单节段腰椎管狭窄症的疗效比较. 中国修复重建外科杂志, 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. 陈举, 张朝春. 全麻下颅骨牵引复位配合颈前路减压融合治疗下颈椎骨折脱位伴关节突交锁. 第三军医大学学报, 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. 张伟, 杨博贵, 刘爱文. 经前后路联合椎弓根钉内固定治疗 67 例颈椎骨折脱位的疗效评价. 中国骨与关节损伤杂志, 2014, 29(7): 645-647.
24. 黄隆, 林其仁, 黄杰苗, 等. 前路手术治疗陈旧性下颈椎骨折脱位. 中国骨伤, 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. 李东方, 周英杰, 史相钦, 等. 平乐正骨手法在下颈椎骨折脱位复位中的作用. 中华中医药杂志, 2018, 33(2): 792-794.
27. 黄云飞, 孟羿彬, 贺欣, 等. 单纯前路手术治疗无脊髓损伤的颈椎骨折脱位伴关节突交锁. 中华骨与关节外科杂志, 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. 刘军, 李伟伟, 祁洁, 等. 下颈椎骨折合并关节突交锁的手术策略. 实用骨科杂志, 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. 朱彦昭, 徐荣明, 马维虎. 颈椎手术中椎动脉损伤的研究进展. 中医正骨, 2010, 22(9): 28-31.
35. 孔抗美, 齐伟力, 王卫东, 等. 颈神经根管切开减压术的应用解剖研究. 中华骨科杂志, 1997, 17(8): 479-481.
36. 程云飞, 杨凌洪, 石恩金. 颈神经根槽和颈椎间孔的应用解剖. 解剖科学进展, 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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