G. Alexander Jones and Edward C. Benzel

Description

Unilateral or bilateral cervical facet dislocations may be reduced during a ventral fusion and fixation procedure. This technique is arguably safer than closed reduction with traction or manipulation under anesthesia, and, if successful, may eliminate the need for a staged ventral and dorsal procedure.

Expectations

Several techniques are described here. They may be safely used to restore anatomic alignment prior to fixation and fusion.

Indications

Open reduction is an option as a primary means of reducing cervical facet dislocations. It may also be used in the event that cervical traction is unsuccessful in restoring alignment.

Contraindications

Care should be taken to perform a complete diskectomy and to take down the posterior longitudinal ligament prior to reduction. If this is not done, the reduction maneuver could cause a fragment of disk or bone to impact the spinal cord during the reduction process, with potentially devastating consequences.

It is emphasized that in the case of a severely comminuted facet fracture, an open ventral reduction is less likely to be successful.

Special Instructions, Position, and Anesthesia

Uncommonly, the dislocation may prove difficult, if not impossible, to reduce, thus requiring an additional dorsal approach. Radiographic confirmation of the reduction should be obtained prior to placement of a bone graft and plate. This may be accomplished with intraoperative plain radiographs or fluoroscopy.

Patients who are not already intubated upon arrival in the operating room should be submitted to an awake fiberoptic intubation to minimize the risk of further neurologic injury. Distraction of the interspace can be accomplished in a controlled manner during the operative procedure. This obviates the need for traction.

Tips, Pearls, and Lessons Learned