[Application and efficacy analysis of manual reduction combined with anterior surgery for cervical dislocation with facet locking and spinal cord injury].

OBJECTIVE

To investigate the clinical outcomes, safety, and indications of manual reduction combined with anterior cervical discectomy and fusion (ACDF) for the treatment of cervical dislocation with facet locking and associated spinal cord injury.

METHODS

A retrospective analysis was conducted on 8 patients with cervical dislocation and facet locking accompanied by spinal cord injury treated between January 2015 and December 2024. The cohort included 6 males and 2 females, aged 27 to 85 years. Injury mechanisms included traffic accidents (3 cases), falls from height (2 cases), ground-level falls (2 cases), and heavy object impact (1 case). All patients underwent attempted closed manual reduction assisted by skull traction. Successful reductions proceeded to anterior cervical discectomy and fusion (ACDF), while failed reductions required conversion to posterior open reduction and internal fixation. Neurological function was assessed using the American Spinal Injury Association (ASIA) impairment Scale, Medical Research Council (MRC) muscle grading, and visual analogue scale (VAS) scores. MRI-based spinal cord compression rates, spinal stability, and complications were recorded. Radiographic parameters (Cobb angle, vertebral slippage distance) and fusion status were observed.

RESULTS

Closed reduction was successful in 7 cases and failed in 1 case. Seven patients completed follow-up, ranging from 21 days to 80 months. Postoperatively, ASIA grades improved in 6 patients, muscle strength improved in 6 patients, and pain VAS decreased in 6 patients. Radiographic examination confirmed good spinal stability and solid fusion. Postoperative complications included cerebrospinal fluid leakage, axial symptoms, and pressure sore infection.

CONCLUSION

Under strict adherence to indications and preoperative risk assessment, manual reduction combined with anterior surgery effectively relieves facet locking, decompresses the spinal cord, restores spinal stability, and promotes neurological recovery. This combined strategy is a feasible option for selected patients with cervical dislocation and facet locking.