Variation in global treatment for subaxial cervical spine isolated unilateral facet fractures

Abstract

Purpose To determine the variation in the global treatment practices for subaxial unilateral cervical spine facet fractures based on surgeon experience, practice setting, and surgical subspecialty. Methods A survey was sent to 272 members of the AO Spine Subaxial Injury Classification System Validation Group worldwide. Questions surveyed surgeon preferences with regard to diagnostic work-up and treatment of fracture types F1–F3, according to the AO Spine Subaxial Cervical Spine Injury Classification System, with various associated neurologic injuries. Results A total of 161 responses were received. Academic surgeons use the facet portion of the AO Spine classification system less frequently (61.6%) compared to hospital-employed and private practice surgeons (81.1% and 81.8%, respectively) (p = 0.029). The overall consensus was in favor of operative treatment for any facet fracture with radicular symptoms (N2) and for any fractures categorized as F2N2 and above. For F3N0 fractures, significantly less surgeons from Africa/Asia/Middle East (49%) and Europe (59.2%) chose operative treatment than from North/Latin/South America (74.1%) (p = 0.025). For F3N1 fractures, significantly less surgeons from Africa/Asia/Middle East (52%) and Europe (63.3%) recommended operative treatment than from North/Latin/South America (84.5%) (p = 0.001). More than 95% of surgeons included CT in their work-up of facet fractures, regardless of the type. No statistically significant differences were seen in the need for MRI to decide treatment. Conclusion Considerable agreement exists between surgeon preferences with regard to unilateral facet fracture management with few exceptions. F2N2 fracture subtypes and subtypes with radiculopathy (N2) appear to be the threshold for operative treatment.

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).…”

“…While the latter system has demonstrated substantial inter-and intraobserver agreement, there is still inconsistency related to the terminology and interpretation of these injuries, which leads to a lack of standardization in the criteria related to the treatment of these injuries (8,31).…”

“…In this context, the clinical spectrum of cervical facet injuries is variable, and its principal symptomatology includes from fracture-dislocations with neurological impairment (from nerve roots or spinal cord) as a consequence of flexion-distraction mechanisms, to nondisplaced injuries of the lateral mass caused by axial load with neck pain (7). There is wide agreement on the need of surgical treatments for fractures with evident displacement and/or neurological impairment (8). Conversely, isolated facet fractures without displacement or an associated neurological damage are still a controversial issue.…”

Delayed Unilateral Facet Interlocking After a Stable Superior Articular Process Fracture of the Cervical Spine: A Case Report

“…However, 21 to 80% of these fractures failed to be treated only with non-operative management. 4 6 11) In a study by Spector and Vaccaro et al on unilateral facet fractures managed without surgery, it was found that 5 of the 24 patients later needed surgery due to either a shift in the fracture position or the onset of radiculopathy. Additionally, out of 6 patients who initially had radicular symptoms, 4 experienced no relief from their symptoms by the end of the study.…”

Verletzungen der subaxialen Halswirbelsäule

“…Eine neuere retrospektive Kohortenanalyse an 39 Patienten konnte hingegen auch bei konservativer Therapie gute Erfolge vorweisen [57]. Auch im internationalen Vergleich ist die Versorgungsstrategie der F3-Verletzungen uneinheitlich [58].…”