The impact of traumatic herniated discs in cervical facets dislocations treatments: systematic review and meta-analysis

• Published in: European spine journal Vol. 31; no. 10; pp. 2664 - 2674
• Main Authors: Onishi, Franz Jooji, Daniel, Jefferson Walter, Joaquim, Andrei Fernandes, Evangelista, Alécio Cristino, de Freitas Bertolini, Eduardo, Dantas, Fernando Rolemberg, Neto, Eloy Rusafa, Mudo, Marcelo Luiz, Brock, Roger, Milano, Jerônimo Buzetti, Botelho, Ricardo Vieira
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-10-2022; Springer Nature B.V
• Subjects: Clinical trials; Intervertebral discs; Magnetic resonance imaging; Medicine; Medicine & Public Health; Meta-analysis; Neurological diseases; Neurosurgery; Patients; Review Article; Skull; Spine (cervical); Surgical Orthopedics; Traction (Orthopedics); Surgical management; Cervical traction; Intervertebral disc herniation; Cervical vertebrae; Facet dislocations
• ISSN: 0940-6719; 1432-0932
• DOI: 10.1007/s00586-022-07290-z

Background
Traumatic facet dislocations in the subaxial cervical spine, also known as locked facets, are commonly associated with neurological deficits. The fear of the presence of an associated traumatic disc herniation and consequent neurological worsening usually causes a delay in the spinal realignment.
This study’s aim is an analysis of safety and efficacy when treating acute cervical traumatic facet dislocations using cranial-cervical traction or posterior open reduction and fixation in the presence of disc herniations.
Methods
Inclusion criteria addressed the following patient groups: (1) MRI diagnosis of traumatic cervical facet dislocations with disc herniation, (2) intervention: either cranial-cervical traction or posterior open reduction and fixation, (4) neurological outcomes after treatment, (5) adult 18 plus years of age, (6) sample sizes greater than 20 patients, (7) English language publication. The following databases and search tools were analyzed: MEDLINE (PubMed), Cochrane Central Register of Controlled Trials (CENTRAL), Google Scholar, and the clinical trial registries (ClinicalTrials.gov), October 2021.
Results
Six studies were found, 2 with posterior open reduction and fixation and 4 with cranial-cervical traction, totalizing 197 patients. Neurological worsening was reported only in 1 case (0.5%).
Conclusions
Traumatic disc herniation in cervical facet dislocations is not an absolute contraindication of cranial-cervical traction or posterior open reduction. Early realignment of the spine could bring more neurological benefits than waiting for an MRI or surgical discectomy. However, caution is needed in this review's data interpretation until prospective and well-designed studies are performed.