CT Scan in Subaxial Cervical Facet Injury: Is It Enough for Decision-Making?

Abstract

Study Design: Cross-sectional survey. Objectives: Assessment of subaxial cervical facet injuries using the AO Spine Subaxial Cervical Spine Injury Classification System is based on CT scan findings. However, additional radiological evaluations are not directly considered. The aim of this study is to determine situations in which spine surgeons request additional radiological exams after a facet fracture. Methods: A survey was sent to AO Spine members from Latin America. The evaluation considered demographic variables, routine use of the Classification, as well as the timepoint at which surgeons requested a cervical MRI, a vascular study, and/ or dynamic radiographs before treatment of facet fractures. Results: There was 229 participants, mean age 42.9 ± 10.2 years; 93.4% were men. Orthopedic surgeons 57.6% with 10.7 ± 8.7 years of experience in spine surgery. A total of 86% used the Classification in daily practice. An additional study (MRI/vascular study/and dynamic radiographs) was requested in 53.3%/9.6%/43.7% in F1 facet injuries; 76.0%/20.1%/50.2% in F2; 89.1%/65.1%/28.4% in F3; and 94.8%/66.4%/16.6% in F4. An additional study was frequently required: F1 72.5%, F2 86.9%, F3 94.7%, and F4 96.1%. Conclusions: Spine surgeons generally requested additional radiological evaluations in facet injuries, and MRI was the most common. Dynamic radiographs had a higher prevalence for F1/F2 fractures; vascular studies were more common for F3/F4 especially among surgeons with fewer years of experience. Private hospitals had a lower spine trauma cases/year and requested more MRI and more dynamic radiographs in F1/F2. Neurosurgeons had more vascular studies and dynamic radiographs than orthopedic surgeons in all facet fractures.

Treatment of unilateral cervical facet fractures without evidence of dislocation or subluxation: a narrative review and proposed treatment algorithm

“…After screening titles, only ten articles were shortlisted for further review according to our selection criteria. Additionally, 26 articles were included by manual citation search to address our narrative review (4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40).…”

Unilateral Cervical Facet Fractures: Relevance of Acute Disc Injury in Conservative Treatment Failure

“…Nevertheless, there is a high degree of consensus among spine surgeons regarding the diagnostic value of MRI. According to a survey conducted by the AOSpine Latin America Trauma Study Group, 53.5%, 76%, and 89.1% of the 229 surgeons polled requested MRI for F1, F2, and F3 fractures, respectively [ 17 ]. As a result, our findings imply that for injuries classified as unstable (F2 and F3) [ 18 – 21 ], conservative management is possible, as long as the MRI study confirms the absence of lesions of structures associated with failure, such as disc and prevertebral edema.…”

“… (A) Thoracic inlet angle (TIA) refers to the angle between the line drawn from the proximal edge of the sternum perpendicular to the center of the upper endplate of T1 and the horizontal. The normal is between 17.5° and 30°, with an average of 23° [ 17 ]. (B) T1 slope refers to the angle formed between the upper platform T1 and the horizontal line.…”

Accuracy and reliability of the AO Spine subaxial cervical spine classification system grading subaxial cervical facet injury morphology

“…The inclusion of other studies could increase the accuracy of the diagnosis. In addition, studies such as MRI, vascular studies and dynamic radiographs are part of the armamentarium to complement the assessment of structural integrity and, therefore, are influencing the decision-making [20]. However, the tomographic basis of the Classification allows greater reproducibility in any trauma center and a shortening in the time to define management.…”