Management of Neglected Bifacet dislocation Subaxial Cervical Spine

In Indian scenario Neglected cervical spine injury is common due to patients seeking native treatment and patients presenting late. The management of a patient who presents late, more than three weeks after initial injury is challenging, and differs from that of the patient who is seen early. We report our experience of three patients whom we treated by posterior and anterior stabilisation under the same anaesthesia. MATERIALS METHODS We operated upon three male patients presented with neglected bifacetal dislocation of the subaxial cervical spine. Two of them had neurological deficit in form of incomplete quadriplegia ASIA Grade c and one without neurological deficit ASIA Grade E . Mean interval of presentation post-trauma was three months (Range 1-6 Months). These three patients were treated by staged Posterior Anterior stabilisation.In Two patients Discectomy by Anterior approach followed by Posterior facetectomy , posterior stabilisation done with interspinous wiring and then anterior fusion done with H-Plate and Tricortical grafting. In another patient Posterior facetecto my and Posterior stabilisation done first followed by anterior fusion with H-Plate and Tricortical grafting .These procedures done under single anaesthesia. And patients followed clinically radiologically for mean 6 months (Range 2 months-2 years) RESULTS Anatomical reduction and restoration of sagittal alignment were achieved in each case which is evident by maintaining the plumbline from occiput .Patient without Neurological deficit retained same neurology, two patients improved from Grade C to D. Graft incorporation seen after 3rd month. Patient has normal range of neck movements CONCLUSION Single approach surgery is not feasible in neglected cases. Identification of disc prolapse with MRI is useful in deciding surgical approach course of management . Combined Antero-postero-anterior approach is usually required to achieve stable anatomic reduction without producing neurological deficit. As forceful reduction of neglected dislocation is dangerous cautious approach is warranted