title: Treatment of isolated cervical facet fractures: a systematic review.
abstract: OBJECT 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.
authors.affiliation: Department of Orthopaedic Surgery, Rothman Institute & Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
authors.forename: Christopher K
authors.initials: CK
authors.lastname: Kepler
authors.affiliation: Department of Orthopaedic Surgery, Rothman Institute & Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
authors.forename: Alexander R
authors.initials: AR
authors.lastname: Vaccaro
authors.affiliation: Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
authors.forename: Eric
authors.initials: E
authors.lastname: Chen
authors.affiliation: Department of Orthopaedic Surgery, Northwestern Memorial Hospital, Chicago, Illinois;
authors.forename: Alpesh A
authors.initials: AA
authors.lastname: Patel
authors.affiliation: Departments of 4 Orthopaedic Surgery and.
authors.forename: Henry
authors.initials: H
authors.lastname: Ahn
authors.affiliation: Department of Orthopaedic Surgery, Mayo Clinic, Rochester, Minnesota.
authors.forename: Ahmad
authors.initials: A
authors.lastname: Nassr
authors.affiliation: Department of Neurosurgery, University of Virginia, Charlottesville, Virginia.
authors.forename: Christopher I
authors.initials: CI
authors.lastname: Shaffrey
authors.affiliation: Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
authors.forename: James
authors.initials: J
authors.lastname: Harrop
authors.affiliation: Department of Orthopaedic Surgery, Rothman Institute & Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
authors.forename: Gregory D
authors.initials: GD
authors.lastname: Schroeder
authors.affiliation: Panorama Orthopedics & Spine Center, Denver, Colorado.
authors.forename: Amit
authors.initials: A
authors.lastname: Agarwala
authors.affiliation: Department of Orthopaedic Surgery, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Marcel F
authors.initials: MF
authors.lastname: Dvorak
authors.affiliation: Department of Neurosurgery, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
authors.forename: Daryl R
authors.initials: DR
authors.lastname: Fourney
authors.affiliation: Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Kirkham B
authors.initials: KB
authors.lastname: Wood
authors.affiliation: Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois.
authors.forename: Vincent C
authors.initials: VC
authors.lastname: Traynelis
authors.affiliation: Department of Orthopaedic Surgery, Emory University, Atlanta, Georgia; and.
authors.forename: S Tim
authors.initials: ST
authors.lastname: Yoon
authors.affiliation: Neurosurgery, University of Toronto, Ontario, Canada.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Fehlings
authors.affiliation: Department of Neurosurgery, University of Maryland, Baltimore, Maryland.
authors.forename: Bizhan
authors.initials: B
authors.lastname: Aarabi
keywords: bilateral facet fracture; cervical; closed reduction; surgical reduction; systematic reviews; trauma; unilateral facet fracture