Posterior Unlocking of Facet Joints Under Endoscopy Followed by Anterior Decompression, Reduction, and Fixation of Old Subaxial Cervical Facet Dislocations: A Technical Note

Objective: Besides the facet joints interlocking, the fibrous tissue or bony callus around the dislocated segments make the reduction for this kind of old injury to be more challenging and different from that of acute injuries. This study is aimed to present 4 cases of old subaxial cervical facet dislocations (SCFD) that were successfully treated with posterior unlocking under endoscopy followed by anterior decompression, reduction, and fixation.

Methods: Between January 2017 and December 2017, 4 patients with old SCFD who underwent posterior unlocking of facet joints under endoscopy followed by anterior decompression, reduction, and fixation were enrolled. A cervical collar was prescribed for 4 weeks postoperatively. Postoperative follow-up evaluations were conducted at 2, 6, and 12 months, including neck visual analogue scale score and neck disability index, radiography, and computed tomography.

Results: The operative time averaged 145 minutes (range, 130-155 minutes). No deterioration of neural function, major vessel rupture, or iatrogenic injury to esophagus occurred. Intraoperative blood loss averaged 45 mL (range, 40-50 mL). Hospital stay for all patients was only 4 days. The neck visual analogue scale score and neck disability index were improved at the final follow-up, and interbody fusion was satisfactory without any radiologic sign of instability or internal failure.

Conclusions: For patients with old SCFD, the unlocking of facet joints via the posterior approach under endoscopy followed by anterior decompression, reduction, and fixation is an alternative technique.