International Orthopaedics

, Volume 43, Issue 5, pp 1255–1262 | Cite as

Multicentre comparative study of Z-shape elevating–pulling reduction and skull traction reduction for treatment of lower cervical locked facets

  • Xinjia WangEmail author
  • Weibin An
  • Qiang Wu
  • Shanpeng Wu
  • Guoxin Li
  • Jican Zeng
  • Yuchun Chen
  • Guanfeng Yao
Original Paper



The aim of this study was to assess the clinical efficacy and safety of Z-shape elevating–pulling reduction as compared to that of conventional skull traction in the treatment of lower cervical locked facet.


Patients with cervical locked facet (n = 63) were retrospectively enrolled from four medical centers and divided into two groups according to the pre-operative reduction method used: Z-shape elevating–pulling reduction (Z-shape elevating group; n = 20) or traditional skull traction reduction (skull traction group; n = 43).


The success rates, efficacy of reduction, and safety were compared between the two groups. The success rates were significantly better in the Z-shape elevating group than in the skull traction group: 87.5% (7/8) vs. 35.3% (6/17) for unilateral locked facet reduction (P = 0.03) and 100% (12/12) vs. 69.2% (18/26) for bilateral locked facet reduction (P = 0.04). There was no obvious change in American Spinal Injury Association (ASIA) grade after the reduction in either group. Combined surgery was necessary in 5% in the Z-shape elevating group vs. 27.9% in the skull traction group. Imaging showed that the segment angle and horizontal displacement were significantly improved after surgery in both groups, with no significant difference between the groups. Follow-up with radiography showed good recovery of the cervical spine sequence; all internal fixation sites were stable, with no loosening, prolapse, or breakage of internal fixators.


Halo vest–assisted Z-shape elevating–pulling reduction appears to be a simple, safe, and effective technique for pre-operative reduction of lower cervical locked facets.


Subaxial cervical dislocation Locked facet Halo-vest Z-shape elevating–pulling reduction Skull traction 



This work was supported by the Shantou University Medical College Clinical Research Enhancement Initiative [grant number 201407] and the Shantou City Science and Technology Plan Major Project, Guangdong Province, China [grant number 20140305].

Compliance with ethical standards

This study was approved by the Ethics Committee of our institution. All patients signed informed consent.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This study was approved by the Ethics Committee of the Second Affiliated Hospital, Shantou University Medical College. All patients signed informed consent.


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Copyright information

© SICOT aisbl 2018

Authors and Affiliations

  • Xinjia Wang
    • 1
    Email author
  • Weibin An
    • 1
  • Qiang Wu
    • 2
  • Shanpeng Wu
    • 3
  • Guoxin Li
    • 4
  • Jican Zeng
    • 1
  • Yuchun Chen
    • 1
  • Guanfeng Yao
    • 1
  1. 1.Department of Spine Surgery, the Second Affiliated HospitalShantou University Medical CollegeShantouPeople’s Republic of China
  2. 2.Yuebei People’s HospitalShaoguanPeople’s Republic of China
  3. 3.Quanzhou First HospitalFujian Medical UniversityQuanzhouPeople’s Republic of China
  4. 4.Peking University Shenzhen HospitalShenzhenPeople’s Republic of China

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