![]() This approach can be reinforced with fixation from the anterior approach as well. However, in patients with ASIA 'C' and 'D' status, the posterior approach is necessary to first to unlocking the jammed facet, and the anatomical fixation is carried out following lateral mass and translaminar screw and rod fixation. If reduction fails in patients with ASIA 'A' and 'B' status, posterior-only fixation by interspinous wiring is justified for anatomical fixation to aid in early rehabilitation. ![]() Sometimes, owing to financial barriers, simple graft placement can also be undertaken. In cases of failed reduction from traction, the clinician can attempt reduction following muscle relaxation after induction of anesthesia. If there is a good reduction following traction, the patients can receive an anterior approach with discectomy or median corpectomy followed by in-situ bony graft fusion or the usage of allograft spacers aided with plate and screw fixations. The treatment algorithm is also determined by the patient's characteristics as well as the expertise of the team. The anterior approach is better suited to deal with the herniated disc, whereas the posterior approach helps restore the posterior tension band. The surgical plan in the management of the patient then varies according to the Meyerding grading system, the ASIA neurological status, and the relevant scoring system of the patient. The failure of reduction needs the posterior reduction of the jumped facets, followed by 360-degree global fixations in neurologically preserved patients. The reduction can then take place by anterior-only fusion. If there is no reduction and the preoperative MR images show the presence of disc prolapse, an anterior approach is the next step, with discectomy followed by open reduction with the aid of a Casper distractor. In cases with locked facets, the clinician should attempt a closed reduction under anesthesia, which is successful in almost 95% of cases. The related article that I've included on this page is about cervical radiographic projections and Matt has created a series of great illustrations to accompany these, so I would certainly recommend checking them out if you are interested.Reduction of the grade of the subluxation in cases of reducible locked facet jointsĬare always needs to avoid cord traction due to heavy tractional weights. I particularly like the section where he points out the differences between the T1 transverse process and the C7 transverse process, and the idea of the articular pillar having a sinusoidal margin on the frontal projection, which becomes really handy to know later in this learning pathway when he discusses facet joint degeneration. The anatomy that Matt chooses to focus on is particularly useful from an interpretation perspective, like appreciating the normal anteroinferior margin of the vertebral body on the lateral projection and the normal airway outline on the AP projection. He assumes a basic level of existing anatomy knowledge, so I've created some additional annotated images for you to scroll through to supplement this. Matt begins his lecture by running through some normal cervical spine radiographic anatomy. Report problem MENU NEXT Audio transcript
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