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 irreducible dislocations of the cervical spine with prolapsed disk are reported. OBJECTIVE: To report the success of a technique for grafting and instrumentation of the anterior cervical spine before reduction. This technique is useful in cervical fracture-dislocations irreducible through the anterior approach that must be approached first from the front because of a prolapsed disc. 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 dislocation of the cervical spine with a prolapsed disc that could not be reduced using the anterior approach. After discectomy and endplate preparation, a tricortical bone graft was harvested from the iliac crest, placed in the interspace, and held with a buttress plate screwed in two places into the superior vertebral body. The anterior wound then was closed. The posterior elements were exposed and the facets reduced by flexing the neck and posteriorly translating the superior segment. Fluoroscopy was used during the reduction 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 fusion 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 posteriorly. No cases of neurologic deterioration occurred, and no complications were attributable to the use of this technique. CONCLUSION: The reported technique was used successfully in the treatment of four patients with irreducible dislocations of the cervical spine.