3:5880. Outcomes of Operative versus Nonoperative Treatment of Unilateral Cervical Facet Fracture Subluxations

Abstract BACKGROUND Few studies have focused on the management of patients with nondisplaced cervical facet fractures. OBJECTIVE To determine the rate of successful nonoperative management and risk factors for instability in patients with acute traumatic, unilateral, nondisplaced cervical facet fractures. METHODS We reviewed patients with single or multilevel unilateral nondisplaced or minimally displaced subaxial cervical facet fractures between 2008 and 2014. Facet fractures were classified as type A1 fractures: superior facet fracture of caudal vertebra; type A2: inferior facet fracture of rostral vertebral; and type A3: floating lateral mass (fracture of pedicle and vertical laminar fracture). All patients were given a trial of nonoperative management with external immobilization using a hard cervical collar. Follow-up clinical data and cervical spine radiographs were analyzed to determine factors associated with instability. RESULTS Thirty-five patients (34 males, mean age 40.2 ± 2.4 yr) were reviewed. The mean follow-up duration was 2.7 ± 0.4 mo. The distribution of fracture types was type A1 (n = 15), type A2 (n = 4), type A3 (n = 5), type A1 and A2 fractures (n = 10), and type A1 and A3 fractures (n = 1). Nonoperative management was successful in 29 patients (82.9%), and 6 patients developed instability requiring surgery. All patients who failed nonoperative management had associated injuries suggesting a more severe mechanism of injury. No significant association was found between the type of facet fracture and outcome (Fisher's exact test, P = .18). CONCLUSION In our series, more than 80% of the patients with unilateral, nondisplaced cervical facet fractures underwent successful nonoperative management in the short term.

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Cervical Facet Fracture Dislocations-Management Algorithm and Tips for Reduction

Open access Journal of Neurology & Neurosurgery ◽

10.19080/oajnn.2017.05.555669 ◽

2017 ◽

Vol 5 (4) ◽

Author(s):

Chaitanya Chikhale

Keyword(s):

Management Algorithm ◽

Fracture Dislocations ◽

Facet Fracture ◽

Cervical Facet

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Complications of a Unilateral Nondisplaced Cervical Facet Fracture in a Patient With Previously Noninstrumented Anterior Cervical Fusion

JAAOS Global Research and Reviews ◽

10.5435/jaaosglobal-d-21-00067 ◽

2021 ◽

Vol 5 (7) ◽

Author(s):

Mohammed A. Munim ◽

Innocent U. Njoku ◽

Christina W. Cheng

Keyword(s):

Anterior Cervical Fusion ◽

Cervical Fusion ◽

Facet Fracture ◽

Cervical Facet

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Unilateral Cervical Facet Fracture-Dislocation

Pediatric Orthopedic Trauma Case Atlas ◽

10.1007/978-3-319-29980-8_70 ◽

2020 ◽

pp. 439-443

Author(s):

Brian E. Kaufman ◽

John A. Heydemann ◽

Suken A. Shah

Keyword(s):

Fracture Dislocation ◽

Facet Fracture ◽

Cervical Facet

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Treatment of Irreducible Bilateral Cervical Facet Fracture-Dislocation with a Prolapsed Disc Using a Prefixed Polyetheretherketone Cage and Plate System

Asian Spine Journal ◽

10.4184/asj.2013.7.2.111 ◽

2013 ◽

Vol 7 (2) ◽

pp. 111 ◽

Cited By ~ 2

Author(s):

Kyung-Jin Song ◽

Hun Park ◽

Kwang-Bok Lee

Keyword(s):

Fracture Dislocation ◽

Facet Fracture ◽

Polyetheretherketone Cage ◽

Prolapsed Disc ◽

Cervical Facet ◽

Plate System

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Anterior-Alone Surgical Treatment for Subaxial Cervical Spine Facet Dislocation: A Systematic Review

Global Spine Journal ◽

10.1177/2192568220907574 ◽

2020 ◽

pp. 219256822090757

Author(s):

Wendy Lee ◽

Chung Chek Wong

Keyword(s):

Systematic Review ◽

Cervical Spine ◽

Open Reduction ◽

Meta Analysis ◽

Fracture Dislocation ◽

Facet Dislocation ◽

Subaxial Cervical Spine ◽

Mesh Terms ◽

Facet Fracture ◽

Cervical Facet

Study Design: Systematic review. Objective: Anterior-alone surgery has gained wider reception for subaxial cervical spine facets dislocation. Questions remain on its efficacy and safety as a stand-alone entity within the contexts of concurrent facet fractures, unilateral versus bilateral dislocations, anterior open reduction, and old dislocation. Methods: A systematic review was performed with search strategy using translatable MESH terms across MEDLINE, EMBASE, VHL Regional Portal, and CENTRAL databases on patients with subaxial cervical dislocation intervened via anterior-alone approach. Two reviewers independently screened for eligible studies. PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) flow chart was adhered to. Nine retrospective studies were included. Narrative synthesis was performed to determine primary outcomes on spinal fusion and revisions and secondary outcomes on new occurrence or deterioration of neurology and infection rate. Results: Nonunion was not encountered across all contexts. A total of 0.86% of unilateral facet dislocation (1 out of 116) with inadequate reduction due to facet fragments between the facet joints removed its malpositioned plate following fusion. No new neurological deficit was observed. Cases that underwent anterior open reduction did not encounter failure that require subsequent posterior reduction surgery. One study (N = 52) on old dislocation incorporated partial corpectomy in their approach and limited anterior-alone approach to cases with persistent instability. Conclusions: This systematic review supports the efficacy and success of anterior reduction, fusion, and instrumentation for cervical facet fracture dislocation. It is safe from a neurological standpoint. Revision rate due to concurrent facet fracture is low. Certain patients may require posteriorly based surgery or in specific cases combined anterior and posterior procedures.

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Traumatic Cervical Unilateral and Bilateral Facet Dislocations Treated With Anterior Cervical Discectomy and Fusion Has a Low Failure Rate

Global Spine Journal ◽

10.1177/2192568217694002 ◽

2017 ◽

Vol 7 (2) ◽

pp. 110-115 ◽

Cited By ~ 9

Author(s):

Alireza K. Anissipour ◽

Julie Agel ◽

Matthew Baron ◽

Erik Magnusson ◽

Carlo Bellabarba ◽

...

Keyword(s):

Risk Factor ◽

Treatment Failure ◽

Anterior Cervical Discectomy ◽

Cervical Discectomy ◽

Single Level ◽

Surgical Data ◽

Facet Fracture ◽

The Mean ◽

Cervical Facet

Study Design: Retrospective radiographic and chart review. Objective: To define the rate and associated risk factors of treatment failure of anterior cervical fusion for treatment of cervical facet dislocations. Methods: Between 2004 and 2014, a retrospective review at a single level 1 trauma center identified 38 patients with unilateral or bilateral dislocated facet(s) treated with anterior cervical discectomy and fusion (ACDF). Two patients were eliminated due to less than 30-day follow-up. Demographic data, initial neurological exams, surgical data, radiographic findings, and follow-up records were reviewed. Results: Of the 36 patients with facet dislocations treated with ACDF using a fixed locking plate, 16 were unilateral and 20 were bilateral. The mean age was 35 years (range 13-58). Mean follow-up was 323 days (range 30-1998). There were 3 treatment failures (8%). Three of 7 (43%) endplate fractures failed ( P < .01), and 1/28 (4%) facet fractures failed ( P = .13). The mean time to failure was 4 weeks (1-7 weeks). One treatment failure had a facet fracture, and all 3 failures had an associated endplate fracture. Conclusion: Treatment failure occurred in 3 out of 36 (8%) patients with facet fracture dislocations treated with anterior cervical discectomy, fusion, and plating. Rates of failure are lower than has been previously reported. Endplate fractures of the inferior level in jumped facets appears to be a major risk factor of biomechanical failure. However, a facet fracture may not be a risk factor for failure. In the absence of an endplate fracture, ACDF is a reasonable treatment option in patients with single-level cervical facet dislocation.

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