Surgical versus conservative treatment of unilateral subaxial non-subluxed facet fractures: A systematic review and meta-analysis

Larkin, Collin J.; Abecassis, Zachary A.; Yerneni, Ketan; Nistal, Dominic A; Karras, Constantine L.; Frankel, Hyman; Ayer, Amit; Dahdaleh, Nader S.

doi:10.1016/j.clineuro.2020.106280

Cited by 6 publications

(10 citation statements)

References 11 publications

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“…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. Thus, F2 and F3 fractures are not unstable due to their morphology.…”

Section: Discussionmentioning

confidence: 59%

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

et al. 2023

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Study Design: Case-control study.Purpose: Analyze association between imaging factors related to the failure of conservative treatment in isolated subaxial cervical facet fractures.Overview of Literature: Facet fracture (F1, F2, and F3 AOSpine) may be stable or unstable depending on clinical and imaging variables, which are not well established. As a result, differences in fracture management lead to differences in surgical or conservative indications, and there is no evidence to predict conservative treatment failure.Methods: Patients were categorized into two groups: six patients (16.2%) with conservative treatment failure (defined as the appearance of neurological symptoms, listhesis >3.5 mm, kyphotic deformation >11°, and/or non-union), and 31 patients (83.7%) with successful conservative management (defined as complete consolidation confirmed by computed tomography [CT] at the 6-month followup). All participants were fitted with rigid collars of the Miami type, and standardized follow-up was performed until consolidation or failure. CT and magnetic resonance imaging (MRI) was used to examine imaging characteristics. Sagittal balance parameters were assessed using CT, and signs of acute disc injury, prevertebral edema, facet synovitis, and interspinous hyperintense signal were assessed using MRI.Results: Thirty-seven patients were diagnosed with unilateral cervical facet fractures between 2009 and 2020. In this sample, acute disc injury had a significative association to failure of conservative treatment in F2 and F3 AOSpine facet fractures, 100% of the failure group presented with traumatic disc injury compared to 9.7% of the successful group, for the other variables: prevertebral edema, 83.7% vs. 41.9%; facet synovitis, 100% vs. 77.4%; and interspinous hyperintensity, 71.4% vs. 38.7%, respectively. With conservative management, all F1 fractures healed successfully. Conservative treatment failed in 20% of F2 fractures and 50% of F3 fractures, respectively. In terms of cervical sagittal balance parameters, there were no significant differences between groups.Conclusions: Conservative management was successful in all F1 fractures. In F2 and F3 types, there was a significant association between acute disc injury and conservative treatment failure.

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Section: Discussionmentioning

confidence: 59%

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

et al. 2023

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“…In line with these findings, Spector et al also reported limited successful treatment rates of immobilization with a rigid collar in nondisplaced subaxial fractures with progressive dislocation in 21% of cases [34]. In another review and meta-analysis of the merit of collars for subaxial non-subluxated facet fractures, the study group concluded that surgical management seems to be the gold standard even for nondisplaced fractures, and that the presence of neurological deficits or even a slight ligamentous involvement is a critical prognostic factor for conservative treatment failure [20]. However, stiff collars may benefit in patients undergoing only an anterior or posterior procedure, whereas a combined procedure would have been optimal.…”

Section: Discussionmentioning

confidence: 99%

Anterior cervical discectomy and fusion with plate versus posterior screw fixation after traumatic subaxial fractures in octogenarians: complications and outcomes with a 2-year follow-up

et al. 2023

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Introduction Surgical intervention for management of spinal instability after traumatic subaxial fractures in octogenarians requires a clear consensus on optimal treatments. This study aimed to provide a guide for more efficient management through comparison and assessment of clinical outcomes and complications of anterior cervical discectomy and fusion with plate (pACDF) and posterior decompression fusion (PDF) instrumentation alone in patients aged 80 years. Methods A single institution retrospective review of electronic medical records was undertaken between September 2005 and December 2021. Comorbidities were assessed using the age-adjusted Charlson comorbidity index (CCI). Logistic regression was used to identify potential risk factors for ACDF complications. Results The rate of comorbidities were similarly high between the pACDF (n=13) and PDF (n=15) groups (pACDF: 8.7 ± 2.4 points vs. 8.5 ± 2.3 points; p=0.555). Patients in the PDF group had significantly longer surgical duration (235 ± 58.4 min vs. 182.5 ± 32.1 min; p<0.001) and significantly higher volumes of intraoperative blood loss (661.5 ± 100.1 mL vs. 487.5 ± 92.1 mL; p<0.001). The in-hospital mortality was 7.7% for the pACDF group and 6.7% for the PDF group. On day 90, the mortality rate increased in both groups from baseline (pACDF: 15.4% vs. PDF: 13.3; p>0.05). Motor scores (MS) improved significantly after surgery in both groups (pACDF: preOP MS: 75.3 ± 11.1 vs. postOP MS: 82.4 ± 10.1; p<0.05; PDF: preOP MS: 80.7 ± 16.7 vs. postOP MS: 89.5 ± 12.1; p<0.05). Statistically significant predictors for postoperative complications included longer operative times (odds ratio 1.2, 95% confidence interval 1.1–2.1; p=0.005) and larger volume of blood loss (odds ratio 1.5, 95% confidence interval 1.2–2.2; p=0.003). Conclusions Both pACDF and PDF can be considered safe treatment strategies for octogenarians with a poor baseline profile and subaxial fractures as they lead to patients substantial neurological improvements, and they are accompanied with low morbidity and mortality rates. Operation duration and intraoperative blood loss should be minimized to increase the degree of neurological recovery in octogenarian patients.

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“…An increased size of fracture fragments and higher degrees of displacement indicate the potential for failure of nonoperative treatment. Pehler et al 33 found that patients with facet fractures with >1 cm of absolute height or those that involve >40% of the intact lateral mass were likely to further displace and fail nonoperative management, while other studies have shown patients with facet fractures that were less than this cutoff did not further displace and could be managed nonoperatively 11,34,35 . Scoring systems, such as the SLIC, and flexion-extension dynamic radiographs may assist in determining the appropriateness of nonoperative management.…”

Section: Nonoperative Managementmentioning

confidence: 99%

Traumatic Cervical Facet Fractures and Dislocations

et al. 2022

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Flexion-distraction, axial loading, and rotational forces can cause various degrees of osseoligamentous disruption of the cervical spine, leading to traumatic cervical facet fractures and dislocations.Low-energy forces lead to minimally displaced facet fractures that often can be treated with immobilization only. High-energy forces are more likely to cause unstable injuries with or without neurologic compromise, which may require surgical intervention.The initial treatment of cervical facet injuries requires patient evaluation and management through the Advanced Trauma Life Support (ATLS) protocols, while definitive management varies based on the biomechanical components of the injury, the neurologic status of the patient, and additional patient factors.Cervical facet injuries often require a multidisciplinary approach to optimize long-term functional outcomes and minimize serious complications.

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Surgical versus conservative treatment of unilateral subaxial non-subluxed facet fractures: A systematic review and meta-analysis

Cited by 6 publications

References 11 publications

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

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

Anterior cervical discectomy and fusion with plate versus posterior screw fixation after traumatic subaxial fractures in octogenarians: complications and outcomes with a 2-year follow-up

Traumatic Cervical Facet Fractures and Dislocations

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