Abstract
Introduction
Cervical lateral mass fractures are frequent injuries encountered in a spine trauma practice. The aim of this study was to define outcomes for operative versus non-operative management by reviewing our experience with these injuries.
Material and Methods
The design of this study was retrospective. It was conducted at University of Alabama Hospitals, USA. Institutional Review Board approval was duly obtained. We used electronic records and ICD codes to identify 34 consecutive cases, presenting to this hospital in the year 2011.
Results
The age range was 22–88 years (mean=45). Most injuries were due to motor vehicle accidents. C7 facets were the most frequently injured (n = 22). The injuries were grouped by fracture orientation into: Coronal split fracture n = 19, sagittal split n = 8, comminuted n = 4, floating (fractured pedicle and lamina) n = 3. Surgical intervention was performed in 16 patients (47%) and non-surgical (rigid collar/halo) in 18 patients (53%). Of surgical cases, 14 received ACDF and 2 received posterior constructs. The follow-up duration was 2 weeks to 12 months (mean 3.2 months). In the surgical group 8 patients were asymptomatic at follow-up, and 8 patients had neck pain. In the non- surgical group 11 patients were asymptomatic and 2 patients had neck pain. In the surgical group definite evidence of fusion was seen on follow-up radiographs in 7 patients and a further 6 patients did not have any movement on flexion extension views. One patient in the surgical group had post-op movement on dynamic X-Ray. In the non-surgical group, 10 patients had no movement on flexion extension views, one patient had minor movement, and no X-Rays were available in the remaining cases.
Conclusion
Clinical outcomes were similar in both surgical and non-surgical groups of facet fractures, with about half in each group being pain free at follow-up. Similarly radiological studies demonstrated good spinal stability in the majority of both surgical and non- surgical groups. There is no clear consensus in the literature regarding the treatment paradigms for cervical facet fractures. Our retrospective data suggests equivalent outcome with both surgical and non-surgical treatment modalities. Further randomized prospective studies are warranted.