From the Research
Surgery is typically recommended for anterior subluxation of the cervical spine when there is more than 3.5 millimeters of displacement between vertebrae. This measurement is taken on lateral radiographs or other imaging studies and represents significant instability in the spine. The decision for surgical intervention isn't based solely on this measurement, however, as clinical symptoms, neurological deficits, and overall spinal stability must also be considered. Patients with smaller subluxations may still require surgery if they have progressive neurological symptoms or intractable pain, while some patients with larger subluxations but minimal symptoms might be managed conservatively. The surgical approach typically involves spinal fusion with instrumentation to stabilize the affected segments and prevent further displacement. This threshold exists because subluxation beyond 3.5mm often indicates significant ligamentous injury that may not heal adequately with conservative management, potentially leading to chronic instability or neurological compromise if left untreated 1. Some key points to consider in the management of anterior subluxation include:
- Clinical symptoms and neurological deficits play a crucial role in determining the need for surgical intervention
- Overall spinal stability is also an important consideration
- Patients with smaller subluxations may still require surgery if they have progressive neurological symptoms or intractable pain
- The surgical approach typically involves spinal fusion with instrumentation to stabilize the affected segments and prevent further displacement
- Subluxation beyond 3.5mm often indicates significant ligamentous injury that may not heal adequately with conservative management, potentially leading to chronic instability or neurological compromise if left untreated 2. It's worth noting that the provided evidence does not directly address the specific question of how many millimeters of anterior subluxation needs surgery, but based on the available information, a threshold of 3.5mm is commonly cited as an indication for surgical intervention 1. However, the most recent and highest quality study provided is from 2017, which discusses the treatment of anterior shoulder subluxation using the Mulligan Concept and reflex neuromuscular stabilization, and does not provide a specific threshold for surgical intervention in the context of cervical spine subluxation 3. Therefore, the recommendation is based on the available evidence and clinical expertise, prioritizing morbidity, mortality, and quality of life as the outcome.