An anterior-first two-stage surgical strategy for neglected traumatic facet dislocation of subaxial cervical spine: a technical note.
9 affiliations
- 1Department of Spine Surgery, The First Affiliated Hospital, Fujian Medical University, No.20 Chazhong Road, Taijiang District, Fuzhou, Fujian, 350005, China.
- 2Department of Orthopedic Surgery,National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, 350212, China.
- 3Department of Orthopedics, The First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, 350005, China.
- 4Jinjiang Municipal Hospital, Jinnan Branch, Quanzhou, Fujian, 362241, China.
- 5Fujian Medical University, Fuzhou, Fujian, China.
- 6Department of Plastic Surgery, The First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, 350005, China. [email protected].
- 7Department of Plastic surgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, 350212, China. [email protected].
- 8Department of Spine Surgery, The First Affiliated Hospital, Fujian Medical University, No.20 Chazhong Road, Taijiang District, Fuzhou, Fujian, 350005, China. [email protected].
- 9Department of Orthopedic Surgery,National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, 350212, China. [email protected].
Abstract
Background
Neglected subaxial cervical traumatic facet dislocation (TFD) presents unique surgical challenges due to fibro-osseous ankylosis and severe segmental instability. Traditional three-stage procedures are effective in complex cases but may increase operative complexity because of repeated patient repositioning and multiple surgical corridors. This study aimed to describe an anterior-first two-stage algorithm for neglected TFD and to report preliminary feasibility observations, including the selective use of a single-screw zero-profile cage as an anterior spacer.Methods
Five patients with neglected subaxial TFD (≥ 3 weeks post-injury) underwent surgery between May 2021 and February 2024. Stage 1 involved anterior discectomy, scar and osteophyte release, and traction-based alignment assessment. If realignment was achieved, anterior cervical discectomy and fusion (ACDF) was performed; if not, a zero-profile cage secured with a single cranial screw was inserted before proceeding to Stage 2 posterior release, reduction, and lateral mass fixation. Clinical outcomes were assessed using the American Spinal Injury Association (ASIA) grade, Visual Analog Scale (VAS) for neck pain, and Neck Disability Index (NDI). Radiographic alignment, fusion, and perioperative parameters were recorded.Results
Five patients (4 men, 1 woman; mean age 49.6 years; mean delay 40.8 weeks) were included. Three patients underwent ACDF plus posterior fixation, whereas two required single-screw zero-profile cage placement before posterior reduction and fixation. Mean operative time was 196 min, mean blood loss was 180 mL, and mean hospital stay was 8 days. Mean VAS decreased from 4.4 to 0.4, mean NDI decreased from 23.8 to 1.6, and three patients improved by one ASIA grade. Mean anterior translation decreased from 44.6% preoperatively to 4.7% at final follow-up, and mean local segmental alignment improved from 18.0° of kyphosis to 0.5° of lordosis. Radiographic evidence of fusion or stable arthrodesis was observed in all patients, with no cage migration, implant loosening, redislocation, or loss of correction.Conclusions
This technical note suggests that an anterior-first, traction-guided two-stage strategy may be technically feasible in selected patients with neglected subaxial cervical TFD. Owing to the small sample size and lack of controls, efficacy, safety, and superiority cannot be established.
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BibTeX
@article{li2026anteriorfirst,
title = {{An anterior-first two-stage surgical strategy for neglected traumatic facet dislocation of subaxial cervical spine: a technical note.}},
author = {Zhechen Li and Yaoqing Chen and Huaqun Zeng and Changyi Jiang and Zhibin Chen and Yiping Chen and Ruomiao Chen and Weihong Xu},
journal = {BMC surgery},
year = {2026},
month = jul,
doi = {10.1186/s12893-026-04067-9},
url = {https://europepmc.org/article/MED/42907971},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - An anterior-first two-stage surgical strategy for neglected traumatic facet dislocation of subaxial cervical spine: a technical note.
AU - Zhechen Li
AU - Yaoqing Chen
AU - Huaqun Zeng
AU - Changyi Jiang
AU - Zhibin Chen
AU - Yiping Chen
AU - Ruomiao Chen
AU - Weihong Xu
PY - 2026
DA - 2026/07/01
JO - BMC surgery
DO - 10.1186/s12893-026-04067-9
UR - https://europepmc.org/article/MED/42907971
AB - Background Neglected subaxial cervical traumatic facet dislocation (TFD) presents unique surgical challenges due to fibro-osseous ankylosis and severe segmental instability. Traditional three-stage procedures are effective in complex cases but may increase operative complexity because of repeated patient repositioning and multiple surgical corridors. This study aimed to describe an anterior-first two-stage algorithm for neglected TFD and to report preliminary feasibility observations, including the selective use of a single-screw zero-profile cage as an anterior spacer.Methods Five patients with neglected subaxial TFD (≥ 3 weeks post-injury) underwent surgery between May 2021 and February 2024. Stage 1 involved anterior discectomy, scar and osteophyte release, and traction-based alignment assessment. If realignment was achieved, anterior cervical discectomy and fusion (ACDF) was performed; if not, a zero-profile cage secured with a single cranial screw was inserted before proceeding to Stage 2 posterior release, reduction, and lateral mass fixation. Clinical outcomes were assessed using the American Spinal Injury Association (ASIA) grade, Visual Analog Scale (VAS) for neck pain, and Neck Disability Index (NDI). Radiographic alignment, fusion, and perioperative parameters were recorded.Results Five patients (4 men, 1 woman; mean age 49.6 years; mean delay 40.8 weeks) were included. Three patients underwent ACDF plus posterior fixation, whereas two required single-screw zero-profile cage placement before posterior reduction and fixation. Mean operative time was 196 min, mean blood loss was 180 mL, and mean hospital stay was 8 days. Mean VAS decreased from 4.4 to 0.4, mean NDI decreased from 23.8 to 1.6, and three patients improved by one ASIA grade. Mean anterior translation decreased from 44.6% preoperatively to 4.7% at final follow-up, and mean local segmental alignment improved from 18.0° of kyphosis to 0.5° of lordosis. Radiographic evidence of fusion or stable arthrodesis was observed in all patients, with no cage migration, implant loosening, redislocation, or loss of correction.Conclusions This technical note suggests that an anterior-first, traction-guided two-stage strategy may be technically feasible in selected patients with neglected subaxial cervical TFD. Owing to the small sample size and lack of controls, efficacy, safety, and superiority cannot be established.
SN - 1471-2482
ER -