Irreducible dislocations of the cervical spine with a prolapsed disc - Preliminary results from a treatment technique

Study Design. The preliminary results from a treatment technique for irredu cible dislocations of the cervical spine with prolapsed disk are reported. Objective. To report the success of a technique for grafting and instrument ation of the anterior cervical spine before reduction. This technique is us eful in cervical fracture-dislocations irreducible through the anterior app roach that must be approached first from the front because of a prolapsed d isc. Summary of Background Data. In the treatment of cervical facet dislocations , a third anterior procedure often is necessary to accomplish the anterior instrumentation and fusion. The reported technique describes a method that eliminates this third procedure by using a cervical buttress plate. Methods. Between August of 1996 and October 1998 four patients had dislocat ion of the cervical spine with a prolapsed disc that could not be reduced u sing the anterior approach. After discectomy and endplate preparation, a tr icortical bone graft was harvested from the iliac crest, placed in the inte rspace, and held with a buttress plate screwed in two places into the super ior vertebral body. The anterior wound then was closed. The posterior eleme nts were exposed and the facets reduced by flexing the neck and posteriorly translating the superior segment. Fluoroscopy was used during the reductio n to ensure that the graft was pulled into the interspace, that the screws in the buttress plate did not pull out of the superior vertebral body, and that the reduced graft did not impinge on the spinal cord, A posterior fusi on was performed and the posterior wound closed. Results. All the patients had consolidation of both anterior and posterior fusions. No cases of instrument failure occurred, either anteriorly or post eriorly. No cases of neurologic deterioration occurred, and no complication s were attributable to the use of this technique. Conclusion. The reported technique was used successfully in the treatment o f four patients with irreducible dislocations of the cervical spine.