Unilateral facet dislocations and fracture-dislocations of the cervical spine

Abstract

We treated 36 patients with unilateral facet dislocations or fracture-dislocations of the cervical spine at the Mayo Clinic between 1975 and 1986. Adequate records were available for 34: ten patients were treated by open reduction and posterior fusion, and 24 by nonoperative management. Of these, 19 had halo traction followed by halo-thoracic immobilisation, four had a simple cervicothoracic orthosis, and one received no active treatment. Anatomical reduction was achieved more frequently in the operative group (60% compared with 25%). Nonoperative treatment was more likely to result in cervical translation on flexion/extension lateral radiographs, and in significant symptoms. Only 36% of the patients treated by halo traction achieved anatomical alignment; in 25% halo traction failed to achieve or maintain any degree of reduction. During halo-thoracic immobilisation, half of the patients lost some degree of reduction and patient satisfaction with the appliance was low. Open reduction and internal fixation of unilateral facet injuries gave better results. 6

Unilateral cervical facet fracture: presentation of two cases and literature review

“…In the operatively treated 10 patients (wiring by posterior approach and fusion), they reported that residual subluxations or angulations were not seen at late period and suffering from pain was less than nonoperatively treated group. 5 In the series by Lifeso et al, 4 none of the six patients treated by halo-vest and 12 patients treated with hard-collar had success. Buchoz and Cheung suggested that patients with unilateral facet fractures with perched facets should be surgically stabilized rather than a trial of halo-vest immobilization.…”

“…[1][2][3][4][5][6] Although oblique views are the best plain radiographic views to diagnose a lateral mass fracture, they are still not as sensitive as CT and the rotation of the neck is dangerous in cervical traumas. Another reason for the lack of sensitivity is the difficulty in imaging the cervical lower spine on lateral plain radiographs.…”

“…5 In the literature, there are controversies concerning the treatment of unilateral facet fractures. If there is coexisting subluxation, cervical spine traction and reduction are tried.…”

“…For postreduction immobilization, halo thoracic devices and internal fixation are the two choices. 4,5 The nonoperative treatment of unilateral facet fractures without subluxation is immobilization with halo-vest or hardcollar. Several series of cervical spine fractures immobilized in a halo vest have documented a high failure rate of facet fractures with subluxation.…”

“…The lower cervical spine, specifically C5-6 and C6-7, has been reported as the most frequently injured portion. 1,2,4,5 In this study, we present two cases with a diagnosis of cervical unilateral facet fracture due to MVA. Although nonoperative treatment with immobilization was the first choice in both the cases, operative intervention was required in one case because of the late developed dislocation.…”