Introduction: Cervical facet fractures are encountered with some frequency in hospitals that see spine trauma patients. There is controversy as to the management of those patient’s with unilateral cervical facet fractures without subluxation. Many advocate surgical intervention for stabilization. The effectiveness of non-operative management of these patients is not known.
Methods: Retrospective review of patients with cervical facet fractures at a level 1 trauma hospital between 2008-12 was performed. Initial cervical spine computed tomography scans were reviewed. Fractures were classified according to the Dvorak classification. Patient data including demographics, cervical facet fracture type/side, presence of additional cervical fractures, neurologic exam, length of follow up, and clinical outcome were obtained and analyzed. Patients were excluded if they had cervical facet fracture subluxation, additional cervical spine fractures at the involved or adjacent levels, or if they had other significant injuries that led to their death or severe neurologic disability. All patients underwent non-operative management with an Aspen cervical collar and analgesics. At clinical follow-up, flexion extension radiographs were obtained.
Results: One hundred and nine patients with cervical facet fractures were identified. Forty-six patients were excluded based on the aforementioned criteria, leaving 63 patients analyzed. Mean patient age was 39 years, 87% of patients were male. There were 63 total unilateral non-subluxed facet fractures. According to the Dvorak classification, there were 44 type A1, 23 type A2, and 10 type A3 fractures. Mean follow up was 104 days. Seven patients (11%), with a total of 10 unilateral facet fractures, developed radiographic subluxation at the fractured level at clinic follow up. Of these there were 5 type A1, 2 type A2, and 3 type A3 fractures.
Conclusions: Patients with unilateral cervical facet fractures without subluxation can successfully be treated non-operatively. However, close clinical and radiographic follow-up is necessary to watch for the possible development of delayed instability.
Patient Care: May affect how subaxial cervical facet fractures without subluxation are treated.
Learning Objectives: By the conclusion of this session, participants should be able to understand the outcomes of non-operative management of unilateral facet fractures of the subaxial cervical spine without subluxation.