Cervical spine injuries associated with lateral mass and facet joint fractures: new classification and surgical treatment with pedicle screw fixation.
To clarify the injury pattern, initial spinal instability, degree of discoligamentous injuries in cervical lateral mass and facet joint fractures, we retrospectively analyzed radiological parameters and introduced a new classification for these injuries. Surgical treatment was performed with cervical pedicle screw fixation (CPS), and overall neurological and radiological outcome was evaluated with a minimum follow-up period of 2 years. Lateral mass fractures were divided into the following four subtypes: separation, comminution, split, and traumatic spondylolysis. The sagittal and frontal alignments were evaluated at both mainly injured and adjacent spinal segments on radiographs. The initial discoligamentous injuries were investigated on magnetic resonance imaging in terms of their frequencies, subtype of injuries, and involved spinal levels. Anterior translation of fractured vertebra was demonstrated in 77% of lateral mass fractures, while 24% of anterior translation was observed, even in cephalad-adjacent vertebrae. On magnetic resonance imaging, signal changes in anterior longitudinal ligament (ALL) and intervertebral disc were demonstrated in 76% of caudal segments and 24% of cephalad segments adjacent to fractured vertebra of lateral mass fractures. The subtype analyses of lateral mass fractures demonstrated high rates of anterior translation in separation, split, and traumatic spondylolisthesis, as well as significant coronal malalignment in comminution and split types (p<0.05). Thirty-one patients underwent surgical treatments using a cervical pedicle screw fixation. The CPS provided the superior capability of deformity correction without pseudoarthrosis, as well as excellent neurological recovery. The average numbers of stabilized segments were minimized without serious complications. In separation, facet joint fracture, and fractures with mild lateral mass comminution, the single level posterior fixation can be considered. The significant unstable injuries of split and comminution type with coronal malalignment can be treated with exclusive two-level posterior stabilization with CPS. The initial evaluation of fracture subtypes helps to successfully minimize the stabilized spinal segment.
Kotani
Yoshihisa
Y
Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, Kita-15, Nishi-7, Kitaku, 060-8638, Sapporo, Japan. y-kotani@med.hokudai.ac.jp
Abumi
Kuniyoshi
K
Ito
Manabu
M
Minami
Akio
A
D000293:Adolescent; D000328:Adult; D000368:Aged; D001863:Bone Screws; D002574:Cervical Vertebrae / Q000293:injuries / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007403:Intervertebral Disc / Q000293:injuries / Q000473:pathology; D017846:Longitudinal Ligaments / Q000293:injuries / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019838:Neck Injuries / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D011843:Radiculopathy / Q000209:etiology / Q000473:pathology / Q000503:physiopathology; D011859:Radiography; D012189:Retrospective Studies; D013119:Spinal Cord Injuries / Q000209:etiology / Q000473:pathology / Q000503:physiopathology; D016103:Spinal Fractures / Q000145:classification* / Q000473:pathology / Q000601:surgery*; D013123:Spinal Fusion / Q000295:instrumentation* / Q000379:methods; D013168:Spondylolisthesis / Q000209:etiology / Q000473:pathology / Q000601:surgery; D021801:Zygapophyseal Joint / Q000293:injuries / Q000473:pathology / Q000601:surgery*
J Trauma. 1993 Jan;34(1):32-9
8437193
Spine (Phila Pa 1976). 2000 Apr 15;25(8):962-9
10767809
Rev Chir Orthop Reparatrice Appar Mot. 1970 Mar;56(2):155-64
4246176
Spine (Phila Pa 1976). 1992 Oct;17(10 Suppl):S447-54
1440042
AJNR Am J Neuroradiol. 1985 Jul-Aug;6(4):633-7
3927682
Spine (Phila Pa 1976). 1997 May 1;22(9):977-82
9152447
Clin Radiol. 1976 Jul;27(3):335-40
975741
Am J Roentgenol Radium Ther Nucl Med. 1960 Apr;83:633-44
13844465
Spine (Phila Pa 1976). 1995 Nov 15;20(22):2442-8
8578396
J Spinal Disord. 1994 Jun;7(3):222-9
7919645
Spine (Phila Pa 1976). 1994 Nov 15;19(22):2529-39
7855677
J Bone Joint Surg Am. 1979 Dec;61(8):1119-42
511875
J Neurosurg. 1989 Jun;70(6):884-92
2715816
Spine (Phila Pa 1976). 1997 Nov 15;22(22):2614-21
9399446
J Spinal Disord. 1994 Feb;7(1):19-28
8186585
Spine (Phila Pa 1976). 1982 Jan-Feb;7(1):1-27
7071658