Surgical Results of Old Distractive-Flexion Injury of Subaxial Cervical Spine: Report of Ten Cases
Torphong Bunmaprasert MD*, Premchai Tirangkura MD*
Affiliation : * Department of Orthopaedics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
Background : Acute distractive-flexion injury of subaxial cervical spine (C3-C7) results in facet subluxation or dislocation.
However, when the injury is missed or neglected, it may cause serious complications including axial pain, deformity and
neurological deficit.
Objective : To demonstrate the pathoanatomy, presentation and management of these injuries.
Material and Method: The present study was conducted retrospectively at Chiang Mai University Hospital during 2008-
2011. Ten patients were classified as to whether 2 unilateral/2 bilateral subluxation or 1 unilateral/5 bilateral dislocation.
Pain, neurological status, imaging and bony fusion were recorded.
Results : The average timing before achieving treatment was 52 days. Five patients had arm pain and radiculopathy; the
other 5 had myelopathy. Nine of 10 patients had posterior element fractures. No disc herniation was found. Pain and
neurological status were improved after surgical decompression, realignment, stabilization and fusion. Bony fusions were
achieved in all follow-up patients.
Conclusion : Most patients have posterior element fractures without any evidence of intervertebral disc herniation. Spinal
malalignment is the main cause of neurological impairment. Posterior-anterior approach is the favorable approach for old
dislocation. Anterior approach is preferred for subluxation.
Keywords : Subaxial cervical facet, Subluxation, Dislocation, Old injury, Presentation and treatment
