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Purpose: The treatment strategy of Distractive-Flexion Injury (DFI) depends on the preoperative reduction, and anterior surgery is usually sufficient for closely reduced DFI. In contrast, reduction-failed injuries should be reduced by more complex procedures. This study evaluated the risk factors of closed reduction and identified the factors that can predict reducibility. Materials and Methods: Fifty patients who underwent surgical treatment due to unstable DFI (Allen stage 2 or higher) from 1994 to 2018 were enrolled in this study. All patients underwent Gardner–Wells tongs traction preoperatively. The patients were subdivided into two groups (group A: reduced, group B: failed reduction). The degree of dislocation and subluxation of the facet joints were analyzed by computed tomography. The major injured facet (MIF) joint was defined as a dislocated joint with more damage, and the opposite facet joint was defined as a minor injured facet joint (mIF) with subluxation. The severity of a MIF injury was analyzed by vertically dividing into quarters of the dislocated facet joint. The severity of the mIF injury was analyzed by dividing the subluxated articular surface facet into quarters. The degree of soft tissue injury was measured by magnetic resonance imaging and divided into three grades. The correlation between preoperative reducibility and other variables was analyzed. Results: Group A contained 27 cases (DFI 2=21, DFI 3=6), and there were 23 cases in group B (nine partial reduction and 14 failures, DFI 2=13, DFI 3=9, DFI 4=1). In DFI 2, the more severe dislocation (D3 and D4), the higher the probability of reduction failure (p=0.001), and the probability of reduction failure increased with less subluxation (S1) (p=0.033). In DFI 3 and 4, the grade of dislocation (D4) also appeared to correlate with the reducibility (p=0.016). Conclusion: The degree of facet involvement could be used as a diagnostic and therapeutic tool in treating DFI of the lower cervical spine. In particular, in DFI 2, severe dislocation (50% or more) or mild subluxation (25% or less), and 75% or more dislocation in DFI 3 and 4 may be a risk factor for interrupting closed traction reduction. [ABSTRACT FROM AUTHOR]

A bilateral facet dislocation after anterior cervical fusion with a plate in distraction-flexion injury without significant instability in plain radiography is very rare. This paper reports a case with a confirmed injury status (C6–7 and C7–T1) by magnetic resonance imaging and computed tomography with no visible fractures or displacement on plain radiography. Anterior cervical fusion (C6–T1) was performed with a cage and plate. On the other hand, three days later, C6–7 bilateral facet dislocation developed with severe neck and radiating pain, and posterior decompression and fusion were performed. [ABSTRACT FROM AUTHOR]

Purpose: The objective of this study is to confirm the effects of risk factors on Adjacent Segment Disease (ASD). Materials and Methods: The subjects of this study were 793 patients who had degenerative lumbar spine disease and were followed-up for an average period of 7.2 years from January of 1999 to September of 2010 after undergoing spinal fusion. To confirm the risk factors, a study on patient factors, surgical factors and radiologic factors was performed. Results: Of 793 patients, 69 patients (group A, 8.7%) underwent a secondary surgical treatment due to ASD. Age of patient, sex, bone mineral density, history of smoking and occupation were not statistically significant. Preoperative body mass index (BMI) (≥25 kg/m2) and postoperative increase of BMI were the patient’s factor in ASD (p=0.02, p＜0.001). Regarding surgical factors, multilevel fusion (more than 3 levels) was higher risk in prevalence of ASD than short level fusion (p=0.01). Degeneration of intervertebral disc (p=0.01) and facet joints (p=0.02), and segmental instability (p=0.001) were also associated with the prevalence of ASD in radiologic factors. Conclusion: To prevent the occurrence of ASD after lumbosacral fusion, selection of the proper level of fusion preoperatively and modifying the life style with body weight control and reduction of hypermobility after fusion surgery are essential. [ABSTRACT FROM AUTHOR]

Atlas fracture accounts for 1% to 3% of all spinal column injuries and 10% of cervical spine fractures, and is most frequently caused by motor vehicle accidents and falls. Only a few cases involving complications after surgical treatment have been reported. We present a case of anterior atlas arch stress fracture accompanied by worsening neurologic symptoms following atlas posterior arch resection for cervical myelopathy with retro-odontoid pseudotumor. [ABSTRACT FROM AUTHOR]

Cervical spondylotic myelopathy (CSM) is a spinal cord dysfunction involving compression of the vascular and neural structures due to bony spurring or soft tissue hypertrophy in patients with degenerative cervical disorders. It presents initially as subtle gait disturbance with gradual deterioration. An elderly patient presenting with gait disturbance due to spasticity and motor weakness of both lower extremities without mental change can be easily misdiagnosed as CSM. We report on a case of gait disturbance due to chronic bilateral subdural hematoma mimicking CSM. [ABSTRACT FROM AUTHOR]