A prospective randomized controlled trial of anterior compared with posterior stabilization for unilateral facet injuries of the cervical spine.
OBJECTIVE
Unilateral facet injuries can be treated with either anterior or posterior fixation techniques with reportedly good outcomes. The two approaches have not been directly compared, however, and consensus is lacking as to which is the optimal method. The primary objective of this study was to determine whether acute postoperative morbidity differed between anteriorly and posteriorly treated patients with unilateral facet injuries.


METHODS
Forty-two patients were prospectively randomized to undergo either anterior cervical discectomy and fusion or posterior fixation. The primary outcome measure was the postoperative time required to achieve a predefined set of discharge criteria. Secondary outcome measures included postoperative pain, wound infections, radiographically demonstrated fusion and alignment, and patient-reported outcome measures.


RESULTS
The median time to achieve the discharge criteria was 2.75 and 3.5 days for anterior and posterior groups, respectively, a difference that did not reach statistical significance (p = 0.096). Compared with those treated using posterior fixation, anteriorly treated patients exhibited somewhat less postoperative pain, a lower rate of wound infection, a higher rate of radiographically demonstrated union, and better radiographically proven alignment. Nonetheless, the anterior approach was accompanied by a risk of swallowing difficulty in the early postoperative period. Patient-reported outcome measures did not reveal a difference between anterior and posterior fixation procedures.


CONCLUSIONS
This prospective randomized controlled trial provided level 1 evidence that both the anterior and posterior fixation approaches appear to be valid treatment options. Although statistical significance was not reached in the primary outcome measure, some secondary outcome measures favored anterior fixation and others favored posterior treatment for unilateral facet injuries.
Kwon
Brian K
BK
Combined Neurosurgical and Orthopaedic Spine Program, Department of Orthopaedics University of British Columbia; V anada. brian.kwon@vch.ca
Fisher
Charles G
CG
Boyd
Michael C
MC
Cobb
John
J
Jebson
Hilary
H
Noonan
Vanessa
V
Wing
Peter
P
Dvorak
Marcel F
MF
D000293:Adolescent; D000328:Adult; D000369:Aged, 80 and over; D000700:Analgesics / Q000627:therapeutic use; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries* / Q000473:pathology / Q000601:surgery*; D017586:Diskectomy / Q000009:adverse effects; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009984:Orthopedic Fixation Devices; D010149:Postoperative Pain / Q000503:physiopathology; D010351:Patient Discharge; D026741:Physical Therapy Modalities; D011182:Postoperative Care; D011859:Radiography; D013123:Spinal Fusion / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome
D000700:Analgesics