Cervical Trauma Stabilisation

The goals of surgery for an unstable neck injury are to restore the alignment of the spine, to take any pressure off the spinal cord or nerves, and to fix the injured segment so it heals in a good position. This can be achieved from the front of the neck (anterior), where a damaged disc or vertebra can be removed and replaced and a plate applied, or from the back (posterior), where screws and rods provide strong fixation. For some injuries, a combined front-and-back operation gives the most secure result. Realigning a dislocation and decompressing the cord are central to protecting neurological function.

The choice between anterior, posterior and combined approaches depends on the type and location of the injury. A facet dislocation with a herniated disc, for example, may be best managed from the front to remove the disc safely before realigning; other patterns are better addressed from the back, or with both. The decision balances the need to decompress the cord, the direction and severity of the instability, and the quality of fixation each approach provides. This is judged carefully for each individual injury, because getting the approach right is important for both safety and durability.

Because the spinal cord is at stake, cervical trauma surgery is carried out with great care to protect neurological function. Realigning a dislocation, decompressing any compression, and stabilising the segment all serve to give the cord the best possible environment to recover and to prevent further injury. Where there is a neurological deficit, timely, careful surgery aims to protect what function remains and support recovery. The whole approach is oriented around the safety of the neural structures.

The evidence guides cervical trauma stabilisation. Systematic reviews and meta-analyses of surgery for subaxial cervical facet dislocations describe good outcomes and inform approach selection, and a randomised trial has compared anterior with posterior stabilisation for unilateral facet injuries. Reviews of anterior-alone treatment for facet dislocation, and of anterior versus posterior versus combined approaches, help match the operation to the injury. This literature supports an individualised, evidence-based choice of approach.

The best operation for a cervical injury depends on the fracture or dislocation pattern, whether the cord or nerves are compressed, and the direction of instability. Where surgery is needed, it aims to realign, decompress and stabilise the neck securely. The plan, realistic expectations and risks are discussed individually, and, in the acute setting, decisions are made with appropriate urgency to protect neurological function.

• —Botelho RV, et al. Surgical treatment of subaxial cervical facet dislocations: systematic review and meta-analysis. Neurosurg Rev 2022. (PMID 35596874)
• —Kwon BK, et al. Randomized trial of anterior versus posterior stabilization for unilateral cervical facet injuries. J Neurosurg Spine 2007. (PMID 17633481)
• —Del Curto D, et al. Surgical treatment of traumatic cervical facet dislocation: anterior, posterior or combined? Arq Neuropsiquiatr 2016. (PMID 27706424)
• —Joaquim AF, et al. Anterior-alone surgical treatment for subaxial cervical facet dislocation: systematic review. Global Spine J 2021. (PMID 32875872)