Unilateral cervical facet dislocation: Biomechanics of fixation

Study Design. Unilateral facet dislocation was created in human cadaveric cervical spines. Specimens were sequentially instrumented with posterior or anterior screws and plates, and studied biomechanically. Objective. To determine the biomechanical differences between anterior and posterior fixation for stabilization of a reduced unilateral cervical facet dislocation. Summary of Background Data. Although previous studies have compared anterior to posterior instrumentation, no data exist on the biomechanics of either type of stabilization after this particular injury. Methods. In 6 human cadaveric cervical spine segments, a reproducible unilateral facet dislocation was created and then unlocked ( reduced). Nondestructive torques were applied to specimens that were intact, injured-reduced, fixated using posterior nonlocking lateral mass plates, and fixated using a bone graft plus an anterior nonlocking plate. Flexion, extension, lateral bending, and axial rotation were measured stereophotogrammetrically. Results. Lateral mass plating was more effective than anterior plating in limiting motion after reduction of a unilateral facet dislocation. Averaged, over all loading directions, lateral mass plates reduced the range of motion to 17% of normal; anterior plates reduced range of motion to 89% of normal. In all loading directions, lateral mass plates performed significantly better than anterior plates ( P < 0.05, paired Student t- tests). Conclusions. Anterior and posterior plating effectively stabilized a reduced unilateral facet dislocation. Lateral mass fixation provided better immobilization than anterior graft and plate.