An operative technique for management of neglected bi-facetal cervical dislocations

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. Methods and Materials: From 2014 to 2019, five patients with neglected bi-facetal cervical dislocation were surgically treated in two stages by the posterior-anterior approach and were followed up for one year. The average age was 47.4 years, with a mean delay of 9.8 weeks. A posterior approach was preferred first, where a reduction was achieved with the help of lateral mass reduction screws after soft tissue release and facetectomy. This was followed by anterior discectomy and stabilization. Neck pain was assessed by the neck disability index (NDI) and the Visual analogue score (VAS). Neurology was assessed by using the modified Japanese Orthopaedic 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. Liberal facetectomy and the use of reduction lateral mass screws provides for a safe and controlled reduction. The reported two-stage technique successfully achieves an anatomical reduction and a stable circumferential fusion.