LITHUANIAN UNIVERSITY OF HEALTH SCIENCES LUHS LIBRARY REPOSITORY

Stuburo kaklinės dalies tarpslankstelinių sąnarių išnirimų atstatymo optimizavimas

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dc.contributor.author Kontautas, Egidijus
dc.date.accessioned 2017-08-21T08:06:43Z
dc.date.available 2017-08-21T08:06:43Z
dc.date.issued 2005
dc.identifier.uri http://repository.lsmuni.lt/handle/1/60038
dc.description.abstract 1. INTRODUCTION Injuries of the lower cervical spine can be among the most devastating injuries of the musculoskeletal system because of the increased risk of the injury to the spinal cord, and also because they so often occur to the younger members of the population (Jones A.A.M. et al., 2003; Sekhon H.S.L. et al., 2001; Ball P.A., 2001). The cervical spine is the most vulnerable spinal segment (Sekhon H.S.L. et al., 2001). The mechanism of cervical spine trauma is defined by the direction and magnitude of the forces that have been applied externally to the head and neck complex resulting in injury (Allen B.L.Jr., 1982). Common injury vectors include flexion, compression, rotation and extension (Allen B.L.Jr., 1982). The pattern of injury is related not only to the external applied force, but also to the initial position or posture of the head and neck at the time of injury (Allen B.L.Jr., 1982). One pattern of these injuries of the lower cervical spine is a facet dislocations (Allen B.L.Jr., 1982). The facet dislocation of the cervical spine result from a hyperflexion injury of the neck (Allen B.L.Jr., 1982). These injuries are characterized radiographically by anterolisthesis of one cervical vertebrae over the other and include the slide anteriorly of the inferior facet of the upper dislocated vertebra over the superior facet of the vertebra below (Allen B.L.Jr., 1982; Razack N. et al., 2000). The facet dislocations of the lower cervical spine represent from 4% to 50% of all cervical spine injuries (Wolf A. et al., 1991; Hadley N.M. et al., 1992; Mahale Y.J. et al., 1993; Razak K.N. et al., 2000). There are many classifications of these cervical spine injuries. According to the comprehensive mechanistic scheme to Allen B.L. et al. the facet dislocations are attributed to distractive flexion injuries and are divided in four stages. According to this classification the first stage of the injury is defined as facet subluxation, the second stage as an unilateral facet dislocation, the third as bilateral facet dislocation. Full vertebral body displacement is defined as a stage four injury (Allen B.L., 1982). These injuries of the cervical spine tend to occur in high-energy mishaps. Several authors have found that motor vehicle accidents are the leading cause of facet dislocations (Hadley N.M. et al., 1992; Vital J.M. et al., 1998; Razak K.N. et al., 2000). It appears also that the lower cervical spine, specifically C5 – C6 and C6 – C7 is injured most frequently (Sabiston C.P. et al., 1988; Vaccaro A.R. et al., 2001; Goldberg W. et al., 2001). The goals of treatment of facet dislocations is primarily preservation of functional and anatomic continuity of the spinal cord and nerve roofs, the restoration of spinal canal alignment to relieve neural compression, establishment of spinal stability to provide freedom from postinjury pain or delayed neurologic problems and, finally, quick restoration of the highest functional level consistent with a patient’s neurologic condition (Beyer C.A. et al., 1991; Cooper P.R. 1993; Cotler J. et al., 1993). How to achieve these goals best is a controversy in the literature (Starr A. et al., 1990; Shapiro S.A. 1993; Vaccaro A.R. et al., 1998; Keynan O. et al., 2003). The primary aim of treatment is to achieve reduction of the facet dislocations (Beyer C.A. et al., 1991). The reduction may be attempted eiher open or closed (Starr A. et al., 1990; Cotler J. et al., 1993; Fazl M. et al., 2001; Keynan O. et al., 2003). Open reduction can be achieved through either an anterior or a posterior approach (Fazl M. et al., 2001; Keynan O. et al., 2003). Closed reduction may be achieved by increasing skull traction or by manipulation using either sedation or a general anaesthetic (Cotler J. et al., 1993; Lu K. et al., 1998). Various maximum weights have been recommended for closed reduction using skull traction (Starr A. et al., 1990; Hadley N.M. et al., 1992; Mahale Y.J. et al. 1993). The efficacy of these techniques has been confirmed by years of clinical experience. However, closed reduction techniques often fail (Shrosbee R. et al., 1979; Sonntag V.K.H., 1981; Kohn A. et al., 1998). Neurological deterioration can occur during or after the attempted closed reduction procedures (Hadley N.M. et al., 1992). Open reduction techniques, therefore, have gained popularity. Open reduction procedures can be performed via the ventral or dorsal approach (Fazl M. et al., 2001; Wiseman D.B. et al., 2003). A dorsal open reduction is performed most frequently and the technique consists of a partial or complete facetectomy, reduction of deformity and dorsal fixation, and fusion. Closed reduction and open dorsal reduction procedures are not without risk. In the scientific literature are described many cases of catastrophic neurological injury that resulted from performing closed reduction of cervical facet dislocations (Hadley N.M. et al., 1992; Mahale Y.J. et al. 1993). The results of numerous studies indicate that the incidence of this association may be higher than previously believed and that the risk of a neurological injury as a result of the attempted closed reduction or open dorsal reduction procedures may be greater than previously appreciated (Mahale Y.J. et al. 1993). A procedure entailing a ventral decompression, reduction and stabilization eliminates the risk of catastrophic neurological sequel resulting from closed or open dorsal reduction, while providing an effective means of safety decompressing and reducing cervical facet dislocations (de Oliveira J.C., 1987; Vital J. et al., 1998). Futhermore, it provides the opportunity to treat only one motion segment by the fusion and placement of instrumentation compared with the common two-motion segment fusion required when using the dorsal approaches (Ordonez B.J. et al., 2000; Fazl M. et al., 2001; Henriques T. et al., 2004). The ventral approach also provides a method by which long – term spinal stability can be obtained (de Oliveira J.C., 1987; Vital J. et al., 1998; Ordonez B.J. et al., 2000; Henriques T. et al., 2004). The secondary aim of treatment is to achieve the stability of the spine (Denis F., 1984; Levine A.M., 1998; White A.A. et al., 1990). Clinical studies show that an anterior strut grafting and anterior cervical plating for unstable lower cervical spine injuries is a safe technique with a union rate approching 100%, no residual kyphosis, and a minimal symptomatic neck pain (Goffin J. et al., 1995; Koivikko M.P. et al., 2000; Fisher G.Ch. et al., 2002). Although, the anterior fusion of spinal segments leads to an excessive stress at unfused adjacent levels and can accelerate its degeneration (McGrory B.J. et al., 1994; Goffin J. et al., 1995). The method of reduction of facet dislocation can influence the rate of the development of degeneration servical spine too (Wolf A. et al., 1991). We believe that it is important to investigate different techniques of the reduction of the facet dislocation and to choose the most effectivenes and safe method. The research work was performed in the department of Polytrauma and department of Spinal cord and peripheral nerves surgery of Kaunas University of Medicine Hospital. We compared two methods of the reduction of facet dislocations. There was a classic closed reduction by cranio – cervical traction and original anterior indirect technique. These methods are similar in their essence, because the reduction of facet dislocation performed without a direct exposure of these parts of vertebra. The reduction of facet dislocation by anterior indirect technique eliminates the need to affect all cervical spine, not like in the reduction by a cranio-cervical traction, because manipulation performed with injured part of the cervical spine. There is difference between these two methods. In consideration with the above-mentioned issues, the aim and tasks of the study were formulated. 2. AIM AND TASKS 2.1 The aim of the study This study was undertaken to asses the effectiveness and safety of the anterior indirect technique of the reduction of facet dislocation which was created and to investigate the influence on development of new degenerative changes of the cervical spine and quality of life of the patients. 2.2 The tasks of the study 1. To evaluate the effectiveness and safety of the original anterior indirect reduction of facet dislocation. 2. To identify the factors, which influence the success rate for the restoration of facet dislocation by cranio-cervical traction. 3. To determinate the frequency of development and type of radiologic degeneration of adjacent levels within twelve months after the reduction of facet dislocation and cervical spine reconstruction and fusion. 4. To identify the quality of life of the patients within twelve months after the reduction of facet dislocation and cervical spine reconstruc-tion and fusion. 3. ACTUALITY AND PRACTICAL VALUE OF THE STUDY In Lithuania, by our knowledge, there were no studies in which the problem of the reduction of facet dislocation was described. Our research work, in which were investigated two techniques of the reduction of facet dislocation is the first in Lithuania. We performed the analysis of the scientific literature and found only a few reports about the open anterior indirect reduction of facets dislocations (Vital J.M. et al., 1999; Ordonez B.J. et al. 2000; Keynan O. et al., 2003; Henriques T. et al., 2004). The authors in these publications described the experience of treatment of patients who suffered from facet dislocations of the cervical spine. Our technique of reduction is different from another which was described in the scientific literature (Vital J.M. et al., 1999; Ordonez B.J. et al. 2000; Keynan O. et al., 2003; Henriques T. et al., 2004). We performed the analysis of the scientific literature and did not find publications in which classic closed reduction by cranio – cervical traction and anterior indirect
dc.language.iso lit
dc.subject Spinal reduction
dc.subject Cervical spine
dc.subject Facet dislocation
dc.subject Spinal fusion
dc.subject Cervical dislocation
dc.subject Spinal trauma
dc.title Stuburo kaklinės dalies tarpslankstelinių sąnarių išnirimų atstatymo optimizavimas
dc.title.alternative Optimization of reduction of facet dislocations of the lower cervical spine
dc.type Daktaro disertacija


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