Asian Spine J.  2023 Feb;17(1):30-36. 10.31616/asj.2021.0437.

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

• Totera JIC
• Vargas GH
• Martini IF
• Romero MG
• Bacciarini AU
• Plaza JVB

• KMID: 2539741
• DOI: http://doi.org/10.31616/asj.2021.0437

Abstract

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.

Keyword

Spinal fracture; Cervical spine; Intervertebral disc; Magnetic resonance imaging scan; Treatment failures