Cervical Post-traumatic Unilateral Locked Facets: Clinical, Radiological and Surgical Remarks on a Series of 33 Patients.

STUDY DESIGN:: Radiographic and clinical analysis.

OBJECTIVE:: Review author's experience with anterior discectomy, interbody fusion and anterior cervical plating in 33 patients with post-traumatic unilateral cervical locked facets.

SUMMARY OF BACKGROUND DATA:: Unilateral cervical locked facet syndrome is a relatively uncommon injury that often is misdiagnosed and therefore subject to a dangerous delay in surgery. Management of this trauma is controversial.

METHODS:: 33 patients with radiologically proven diagnosis of postraumatic unilateral cervical locked facets were treated by skull traction and surgical operation from January 2005 to December 2009. All patients preoperatively were assessed for neurological examination and underwent XRays, MRI and CT evaluation of the cervical spine.

RESULTS:: The unilateral locked facet level was C4-C5 in 13 patients, C5-C6 in ten, C6-C7 in eight and C3-C4 in two patients. After closed reduction attempt with Crutchfield system, the correct alignment was achieved in 30 patients, who underwent anterior discectomy with cage, interbody fusion and anterior cervical plating. In 3 patients there was an overdistraction and therefore a closed reduction was not possible, so they were firstly operated by posterior approach with opened reduction of the facets, lateral mass screws and posterolateral fusion. In two of these patients there was an anterior fragment of the disc in the canal, so was also performed an anterior approach with discectomy, cage and plating. There were no surgery-related complications. Post-operative neurological status was unchanged in the three patients with tetraplegia and improved in eight of the ten patients with radiculopathy. Fusion was obtained in all patients, as showed in the clinical and radiological follow-up.

CONCLUSION:: The authors conclude that an anterior approach provides a safe and effective alternative for the treatment of patients with post-traumatic unilateral cervical locked facet, when preoperatively the cervical alignment of the dislocation is achieved with a closed reduction.