Outcomes of halo immobilization in the management of subaxial cervical facet fractures.
BACKGROUND
Spinal injury causes a significant burden on patients, families and health services. Cervical facet fractures are uncommon, and there is a paucity of functional and health-related quality-of-life data in patients who are managed non-operatively for this injury.


METHODS
Victorian State Trauma Registry patients managed in a halothoracic brace for cervical facet injuries from August 2006 to June 2013 were included. Health status (12-item Short-Form health survey), function (Glasgow Outcome Scale-Extended), pain and return to work outcomes were assessed at 6, 12 and 24 months post-injury. Subgroup analysis was performed for age, sex, comorbidity, compensable status, Injury Severity Score (ISS) and education.


RESULTS
Outcome data were available for 54 patients, with road trauma being the most common mechanism (69%), followed by a fall from height (18%). Overall, good 24-month function was achieved in 35% of patients, and 51% and 77% of patients reported good physical and mental health status, respectively. Ongoing moderate-severe neck pain was present in 19% of patients. Poorer function was associated with compensable status (P = 0.05), an ISS > 12 (P = 0.001) and a lower level of education (P = 0.04). Poorer physical health status was associated with age ≥50 (P = 0.05), pre-existing comorbidities, an ISS > 12 (P = 0.04) and a lower level of education (P = 0.03).


CONCLUSIONS
Although many patients achieved good function and health status by 24 months, neck pain remains prevalent. A number of demographic factors were associated with a poorer outcome. This understanding helps to inform prognosis when managing this injury.
Department of Orthopaedic Surgery, Alfred Health, Melbourne, Victoria, Australia.
David
D
Sime
Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
Belinda
B
Gabbe
Department of Orthopaedic Surgery, Alfred Health, Melbourne, Victoria, Australia.
Susan
S
Liew
D000328:Adult; D002574:Cervical Vertebrae / Q000293:injuries*; D019468:Disease Management; D005260:Female; D005592:Fracture Fixation / Q000295:instrumentation / Q000379:methods*; D006304:Health Status; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D009989:Orthotic Devices; D010147:Pain Measurement; D062707:Return to Work; D016103:Spinal Fractures / Q000628:therapy*; D016896:Treatment Outcome
cervical; facet; halo; outcome; pain