부산대학교 도서관

Introduction The section of the cervical spine from C3 to C7 is called the subaxial cervical spine (SCS) (1,2). The incidence of cervical spine fractures increased as a result of [...]
Objective: To perform an analysis of the surgical approach choice in subaxial cervical spine (SCS) facet dislocations. Method: The inclusion criteria were as follows: radiologically confirmed traumatic SCS facet dislocation, 18-70 years of age, stable medical condition, and isolated cervical trauma, The management scheme was based on the presence of traumatic disc herniation (TDH) and the grade of dislocation according to the Allen and Ferguson classification (AFC), In the absence of TDH, the reduction was attempted via traction under general anesthesia before surgery, In the presence of TDH, the reduction was attempted after anterior discectomy, Posterior open reduction was performed in case of an unsuccessful reduction attempt, Anterior stabilization was sufficient in AFC distractive flexion stage (DFS) 2 fractures while combined stabilization was performed in DFS 3 and 4 fractures. Results: Thirty-two patients were included in the study, TDH was detected in 14 patients, The number of patients with DFS 2, 3, and 4 fractures was 6, 18, and 8, respectively, Posterior open reduction was needed in 9 patients, Anterior stabilization was performed in 6 patients (3 with TDH, 3 without TDH) and combined stabilization was performed in 26 patients (11 with TDH, 15 without TDH) via 6 anterior, 7 anterior-posterior, 15 posterior-anterior, and 4 anterior-posterior-anterior approaches, Satisfactory follow-up results were achieved in radiological and neurological evaluations, and neck pain scores. Conclusion: The treatment algorithm for subaxial facet dislocations based on DFS and TDH presence provided satisfactory results, Keywords: Allen and Ferguson classification, decision-making, facet dislocation fracture, subaxial cervical spine, subaxial injury classification and Severity scale, traumatic disc herniation Amac: Bu calismada subaksiyel servikal omurga (SSO) faset dislokasyon frakturlerinde cerrahi yaklasim secimi algoritmasi gelistirilmesi amaclanmistir, Yontem: Calismaya dahil edilme kriterleri su sekildeydi: Radyolojik olarak gosterilmis travmatik SSO faset dislokasyon frakturu, 18-70 yas, medikal olarak stabil durum ve izole servikal travma varligi, Tedavi algoritmasi temel olarak, travmatik disk herniasyonu (TDH) varligina ve Allen ve Ferguson siniflamasina (AFS) gore dislokasyon derecesine gore duzenlenmekteydi, Radyolojik incelemelerde TDH saptanmazsa, cerrahi girisim oncesinde genel anestezi altinda traksiyon ile reduksiyon denenmesi yapilmaktaydi, TDH varliginda ise traksiyon denemesi oncesinde anterior diskektomi yapilmaktaydi, Eger traksiyon ile reduksiyon girisimi basarisiz olursa, posterior acik reduksiyon yapilmaktaydi, AFS'sine gore distraktive fleksiyon evre (DFE) 2 frakturlerinde anterior stabilizasyon uygulanirken, DFE 3 ve 4 dislokasyonlarda kombine stabilizasyon yapilmaktaydi. Bulgular: Calismaya 32 hasta dahil edildi, On dort hastada radyolojik incelemelerde TDH saptandi, Alti hastada DFE 2, 18 hastada DFE 3 ve 8 hastada DFE 4 faset dislokasyon frakturu mevcut idi, Posterior acik reduksiyon 9 hastada gerekli oldu, Alti hastaya (3 TDH'si olan, 3 TDH'si olmayan) anterior stabilizasyon ve 26 hastaya (11 TDH'si olan, 15 TDH'si olmayan) kombine stabilizasyon uygulandi, Alti anterior, 7 anteriorposterior, 15 posterior-anterior ve 4 anteriorposterior-anterior yaklasim uygulandi, Radyolojik, norolojik degerlendirmelerde ve boyun agrisi skorlarinda tatmin edici sonuclar elde edildi. Sonuc: DFE ve TDH varligina gore olusturulan subaksiyel faset dislokasyonlari icin cerrahi tedavi algoritmasi ile basarili sonuclar elde edilmistir. Anahtar kelimeler: Allen ve Ferguson siniflamasi, faset dislokasyon frakturu, karar verme, subaksiyel servikal omurga, subaksiyal yaralanma siniflamasi ve Siddet olcegi, travmatik disk hernisi