Subaxial cervical spine fractures with facet joint dislocation: Surgical management, technique, and results in a retrospective series of 36 patients.

Objective: Subaxial cervical spine fractures with facet dislocation are burdened by a high risk of neurological impairment. The surgical management of this severe clinical condition is poorly standardized, concerning the role of closed reduction and the use of anterior, posterior, or circumferential approaches. We performed a retrospective evaluation of our series to assess the safety and efficacy of our surgical strategy. Materials and Methods: Transcranial traction was progressively applied, followed by anterior decompression and arthrodesis. Whether adequate reduction was not obtained with traction, or in case of comminution of the posterior elements, a combined posterior-anterior approach was undertaken. In addition, we report the use of intraoperative ultrasound for the assessment of neural decompression. Results: A total of 36 patients were treated in this series. The most frequently affected level was C6-C7 (14/36), and motor-vehicle accident was the most common mechanism of injury (20/36). According to AO Spine Subaxial Classification, C-F4 was the main type of lesion (25/36). The anterior approach was effective in 21 out of 36 cases, whereas a combined approach was needed in 12/36. Three patients were operated on only posteriorly. Frankel grade at follow-up was unchanged in 27/36, ameliorated in 6, and 3 patients died within 14 days. Conclusion: The anterior approach resulted to be sufficient in more than 50% of patients, and our findings corroborate the usefulness of closed traction. Posterior and circumferential stabilization were reserved for irreducible dislocations or substantial destruction of the posterior elements. Among patients initially treated anteriorly, a second operation was necessary in only two cases.