cervical_facet_dislocation

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cervical_facet_dislocation [2024/02/06 22:57] – created - external edit 127.0.0.1cervical_facet_dislocation [2024/05/17 12:21] (current) – administrador
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 +Cervical [[subluxation]] of more than 50% or [[perched facet joint]] cervical [[luxation]]. These injuries are definitely a sign of severe disruption of the [[posterior ligamentous complex]] and therefore an indicator of at least a B-type or even C-type injury.
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 +In the presence of vertebrobasilar symptoms, a CT- or MR-angiogram is recommended.
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 +Possible nerve root compression by the facet fragment may therefore require an additional posterior approach in case of an anterior stabilization.
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 +Unilateral or bilateral locked facets require a differentiated concept in order to ensure a safe reduction without neurological compromise.
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 +In general, the closed reduction should be performed under fluoroscopy by an experienced spine surgeon on operating room (OR) standby or directly in the OR. To ease closed reduction patient relaxation is recommended. Because there is an inverse correlation between time since luxation and reduction success, the closed reduction should be performed as early as safely possible.
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 +In neurologically intact patients, it is recommended to perform the closed reduction in the anesthetized patient in the OR directly prior to surgery. In case a closed reduction is not possible, immediate anterior decompression is performed, followed by an open reduction attempt with a distractor (eg, [[CASPAR Cervical Distractor]]). Usually, the reduction should be achieved with this algorithm in more than 95% of locked facets.13,14 In the rare case that an anterior open reduction may not be achieved, the reduction has to be performed by an open posterior approach following the mandatory complete anterior decompression.
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 +In case the surgeon prefers primary open posterior reduction, a preoperative MRI is mandatory to exclude herniated disc material, which may constrain the spinal canal following reduction without anterior decompression (see section “Diagnostics”).
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 +Patients with neurological compromise should undergo reduction as soon as possible; however, the benefits and risks of immediate reduction should be thoroughly assessed
 +((Schleicher P, Kobbe P, Kandziora F, Scholz M, Badke A, Brakopp F, Ekkerlein H, Gercek E, Hartensuer R, Hartung P, Jarvers JS, Matschke S, Morrison R, Müller CW, Pishnamaz M, Reinhold M, Schmeiser G, Schnake KJ, Stein G, Ullrich B, Weiss T, Zimmermann V. Treatment of Injuries to the Subaxial Cervical Spine: Recommendations of the Spine Section of the German Society for Orthopaedics and Trauma (DGOU). Global Spine J. 2018 Sep;8(2 Suppl):25S-33S. doi: 10.1177/2192568217745062. Epub 2018 Sep 7. PMID: 30210958; PMCID: PMC6130109.))
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 +A Separation fracture
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 +B Comminuted fracture
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 +C Split fracture
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 +D Traumatic spondylolisis
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 +Cervical facet fractures more frequently involves superior facet may be unilateral or bilateral.
  
 ===== Epidemiology ===== ===== Epidemiology =====
  • cervical_facet_dislocation.txt
  • Last modified: 2024/05/17 12:21
  • by administrador