Background: Bi-facetal cervical dislocations can be missed due to misinterpretation of clinical signs and radiographs at initial assessment. In such cases, an ensuing fibrous union makes reduction and surgical stabilization both difficult and challenging. Multiple stage approaches are required for its management. The guidelines for the surgical treatment of neglected bi-facetal dislocation are not yet clearly defined. The aim of this retrospective case series is to discuss the operative approach for the management of neglected bi-facetal cervical dislocation and the assessment of its clinical outcomes.
Materials and methods: From 2013 to 2021, eight patients with neglected bi-facetal cervical dislocation were surgically treated with global stabilization and fusion (front back front) and were followed up for 1 year. The average age was 51 years, with a mean delay of 9 weeks. An anterior approach was preferred first where anterior discectomy was done and then posterior approach was preferred, where a reduction was achieved with the help of lateral mass reduction screws after soft tissue release and facetectomy. This was followed by patient placing again supine and tricortical iliac crest graft harvested and placed in the dislocated segment and stabilized with locking plates and screws. Neck pain was assessed by the neck disability index (NDI) and the visual analog score (VAS). Neurology was assessed by using the modified Japanese Orthopedic Association (mJOA) score. Sagittal alignment and fusion were also recorded.
Results: Anatomical reduction was achieved in all patients without neurological worsening. NDI, VAS, and mJOA score were significantly improved after the surgery. In all patients, complete fusion occurred at the final follow-up and no complications were encountered.
Conclusion: It is difficult to reduce a neglected bi-facetal dislocation. Global stabilization and fusion (front back front): (1) anterior discectomy, (2) posterior facetectomy and reduction, and (3) anterior fusion with bone grafting. This has resulted in good anatomical reduction and a stable circumferential fusion without neurological deterioration.
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