Abstract
OBJECTIVE: In this clinically based systematic review of cervical facet fractures, the authors' aim was to determine the optimal clinical care for patients with isolated fractures of the cervical facets through a systematic review. METHODS: A systematic review of nonoperative and operative treatment methods of cervical facet fractures was performed. Reduction and stabilization treatments were compared, and analysis of postoperative outcomes was performed. MEDLINE and Scopus databases were used. This work was supported through support received from the Association for Collaborative Spine Research and AOSpine North America. RESULTS: Eleven studies with 368 patients met the inclusion criteria. Forty-six patients had bilateral isolated cervical facet fractures and 322 had unilateral isolated cervical facet fractures. Closed reduction was successful in 56.4% (39 patients) and 63.8% (94 patients) of patients using a halo vest and Gardner-Wells tongs, respectively. Comparatively, open reduction was successful in 94.9% of patients (successful reduction of open to closed reduction OR 12.8 [95% CI 6.1-26.9], p < 0.0001); 183 patients underwent internal fixation, with an 87.2% success rate in maintaining anatomical alignment. When comparing the success of patients who underwent anterior versus posterior procedures, anterior approaches showed a 90.5% rate of maintenance of reduction, compared with a 75.6% rate for the posterior approach (anterior vs posterior OR 3.1 [95% CI 1.0-9.4], p = 0.05). CONCLUSIONS: In comparison with nonoperative treatments, operative treatments provided a more successful outcome in terms of failure of treatment to maintain reduction for patients with cervical facet fractures. Operative treatment appears to provide superior results to the nonoperative treatments assessed.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 347-354 |
| Number of pages | 8 |
| Journal | Journal of Neurosurgery: Spine |
| Volume | 24 |
| Issue number | 2 |
| DOIs | |
| State | Published - Feb 2016 |
Funding
The authors report that AOSpine and the Association for Collaborative Spine Research provided resources to help with this paper. The authors report the following. Dr Schroeder: funding from Medtronic for travel to meetings. Dr. Kepler: consultant for Healthgrades. Dr. Vaccaro: consultant for Medtronic, Stryker Spine, Globus, Stout Medical, Gerson Lehrman Group, Guidepoint Global, Medacorp, Innovative Surgical Design, and Orthobullets; expert testimony for Ellipse; service on scientific advisory board/board of directors/service on committees for innovative surgical design for Spinicity, AOSpine, and Association of Collaborative Spine Research; royalties from Thieme, Jaypee, Elsevier, Taylor Francis, Aesculap, Globus, Medtronic, Stryker, and Biomet Spine; institutional support from Cerapedics; owns stock in Spine Medica, Computational Biodynamics, Progressive Spinal Technologies, Spinology, Small Bone Innovations, Cross Current, In Vivo, Flagship Surgical, Advanced Spinal Intellectual Properties, Cytonics, Bonovo Orthopaedics, Electrocore, Gamma Spine, Location Based Intelligence, FlowPharma, R.S.I., Replication Medica, Globus, Stout Medical, Rothman Institute and Related Properties, Innovative Surgical Design, Spinicity; and Paradigm Spine. Dr. Patel: consultant for Biomet, DePuy (A Johnson and Johnson Company), Stryker, Zimmer, GE Healthcare Nocimed, Amedica, Ulrich, and Relievant; direct stock ownership in Amedica, Trinity Orthopaedics, Cytonics, Nocimed, and Vital 5; IP royalties from Amedica and Ulrich Medical USA; publishing royalties, financial or material support from Springer; board or committee member AAOS, American College of Surgeons, American Orthopaedic Association, AOSpine North America, Cervical Spine Research Society, Indo-American Spine Alliance, Lumbar Spine Research Society, and North American Spine Society; and editorial or governing board of Journal of the American Academy of Orthopaedic Surgeons, Surgical Neurology International, and Wolters Kluwer Health-Lippincott Williams and Wilkins. Dr. Nassr: grants from AOSpine, CSRS, and OREF; and fellowship support from AOSpine. Dr. Harrop: consultant for DePuy and Bioventus; grants from NACTN; and fellowship Support from AOSpine NA. Dr. Shaffrey: consultant for Biomet, Globus, Medtronic, NuVasive, and Stryker; stock ownership in NuVasive; patent holder with Biomet, Medtronic, and NuVasive; royalties from Biomet and Medtronic; grants from NIH, Department of Defense, AO, NREF, and NACTN; fellowship support: NREF, AO, and UVa; non-study-related support form ISSG and DePuy Synthes. Dr. Agarawala: consultant for Medtronic. Dr. Fourney: research support from Asubio Pharmaceuticals; grants from Canadian Institute of Health Research, Rick Hansen Foundation, Saskatchewan Health Research Foundation, Royal University Hospital, and AOSpine, and fellowship support from AOSpine. Dr. Wood: stock ownership in TranS1; other financial or material support from Globus Medical and OREF; research support from K2M; editorial or governing board of Spine and Spinal Deformity; and fellowship support form Synthes. Dr. Traynelis: consultant for, royalties from, patent holder with, and research support from Medtronic; grants from NIH; and fellowship support from Globus. Dr. Yoon: consultant for Meditech Advisors, and Stryker; and intellectual property royalties from Stryker and Meditech; stock ownership in Alphatec Spine, Meditech Advisors, Medyssey, and Phygen; editorial or governing board for American Journal of Orthopedics, Journal of Bone and Joint Surgery-American, Journal of Orthopaedic Research, The Spine Journal, Spine; and board or committee member of International Society for the Study of the Lumbar Spine.
Keywords
- Bilateral facet fracture
- Cervical
- Closed reduction
- Surgical reduction
- Systematic reviews
- Trauma
- Unilateral facet fracture
ASJC Scopus subject areas
- Clinical Neurology
- Neurology
- Surgery