Facet fracture-dislocation injuries of the cervical spine.
Sixty-eight patients with acute traumatic cervical facet fracture-dislocation injuries are presented. These patients represented 6.7% of all cervical spine fractures identified over a 12-year period. Thirty-one patients had unilateral facet injuries and 37 had bilateral facet injuries. Neurological morbidity was 90% and was most severe among bilateral facet injury patients (84% complete injuries). Spinal shock was identified in 13 patients and was a poor prognostic indicator for the subsequent recovery of associated neurological deficits. Closed reduction was attempted in 66 of 68 patients and was successful in 58% of the patients. Seven patients deteriorated. Open reduction-internal fixation was successful in 83% of 24 patients with a 4% morbidity. Seventy-eight percent of patients improved with rapid closed reduction, and 60% improved with open reduction-internal fixation; however, only 10 patients of the entire 68 made significant neurological recoveries. In these 10 patients, the timing of decompression-realignment appeared to be more important than the means of reduction.
Hadley
M N
MN
Division of Neurological Surgery, Barrow Neurological Institute, Phoenix, Arizona.
Fitzpatrick
B C
BC
Sonntag
V K
VK
Browner
C M
CM
D000293:Adolescent; D000328:Adult; D002574:Cervical Vertebrae / Q000293:injuries*; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal; D006801:Humans; D004204:Joint Dislocations / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D008297:Male; D008349:Manipulation, Orthopedic; D008875:Middle Aged; D009104:Multiple Trauma / Q000401:mortality; D009422:Nervous System Diseases / Q000209:etiology; D016103:Spinal Fractures / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D015996:Survival Rate; D014143:Traction; D016896:Treatment Outcome