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The Timing and Influence of MRI on the Management of Patients With Cervical Facet Dislocations Remains Highly Variable: A Survey of Members of the Spine Trauma Study Group

Grauer, Jonathan N. MD*; Vaccaro, Alexander R. MD; Lee, Joon Y. MD; Nassr, Ahmad MD§; Dvorak, Marcel F. MD; Harrop, James S. MD; Dailey, Andrew T. MD; Shaffrey, Christopher I. MD**; Arnold, Paul M. MD††; Brodke, Darrel S. MD‡‡; Rampersaud, Raja MD§§

doi: 10.1097/BSD.0b013e31816a9ebd
Original Articles

Background Traumatic cervical facet dislocations are potentially devastating injuries. Magnetic resonance imaging (MRI) is an excellent means of assessing ligamentous disruption, disk herniation, and compression of the neural elements. However, despite an improved understanding of these facet dislocations with imaging, treatment remains controversial.

Purpose To survey the timing and influence of MRI on the management of patients with traumatic cervical facet dislocations.

Study design Questionnaire study.

Methods Clinical vignettes, plain radiographs, and computed tomography scans of 10 cases of cervical facet dislocation were presented to 25 fellowship trained spine surgeons. Participants were analyzed as to their next step in diagnosis or treatment: closed reduction, obtaining an MRI, or proceeding directly with open treatment. A revised vignette was then presented; however, on this occasion, an MRI was included with the imaging and had been obtained before a reduction attempt. Participants were then surveyed on their choice of closed or open reduction. Each of the vignettes consisted of 3 different clinical scenarios based on neurologic examination: intact, incomplete, or complete spinal cord injury.

Results The interrater reliability of treatment decisions was very poor, and the reliability after MRI was available and was significantly worse when the patient was considered to have a complete spinal cord injury. After reviewing the MRI, orthopedic surgeons were significantly more likely to choose a closed versus open reduction. Neurosurgeons were significantly more likely than orthopedic surgeons to order an MRI before open or closed treatment.

Conclusions The timing and utilization of MRI for patients with traumatic cervical facet dislocations remains variable. Further outcome analysis in the form of evidence-based algorithms is necessary to optimize patient management and outcomes.

*Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, CT

Department of Orthopedic Surgery

Department of Neurosurgery, Thomas Jefferson University, Philadelphia

Department of Orthopedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA

§Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN

Department of Orthopedic Surgery, University of British Columbia, Vancouver, BC

Department of Neurosurgery

‡‡Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT

**Department of Neurosurgery, University of Virginia, Charlottesville, VA

††Department of Neurosurgery, University of Kansas Medical Center, Kansas City, KS

§§Department of Surgery, University of Toronto, Toronto, ON

Supported by the Spine Trauma Study Group and Medtronic Sofamor Danek.

This study was approved by the University of Pittsburgh Medical Center IRB.

Reprints: Jonathan N. Grauer, MD, Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, PO Box 208071, New Haven CT 06510 (e-mail: jonathan.grauer@yale.edu).

Received for publication December 10, 2007; accepted January 5, 2008

© 2009 Lippincott Williams & Wilkins, Inc.