Circumferential fusion for irreducible bilateral cervical locked facets

Objective: The aim of this study is to evaluate the efficacy and stability of circumferential fusion in the management of irreducible bilateral cervical locked facets especially with disc herniation. Patients & Methods: 15 patients with traumatic bilateral cervical locked facets were studied. After failure of closed reduction: Group [A] included 8 cases [traumatic disc herniation]: anterior decompression then posterior unlocking, lateral mass fixation followed by anterior fixation/fusion. Group [B]: included 7 patients with wide canals, posterior unlocking and lateral mass fixation followed by anterior approach for fixation / fusion. All cases were evaluated for neurological outcome and radiological evidence of fusion. Results: All patients were safely reduced with circumferential fusion / fixation. according to Frankel classification: 7 patients were grade B, 4 improved to grade C, 3 remained stationary, 6 patients were grade C, 5 improved to D, two remained stationary, and one patient was grade D improved to E. No neurological deterioration. Complete postoperative realigement was achieved and maintained during follow up. Conclusions: Circumferential fusion provides a safe and effective alternative for management of patients with bilateral irreducible locked facets resulting in superior stability as it treats the anterior and posterior pathology simultaneously.