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Clinical Outcomes of 90 Isolated Unilateral Facet Fractures, Subluxations, and Dislocations Treated Surgically and Nonoperatively

Dvorak, Marcel F. MD*; Fisher, Charles G. MD, MHSc*; Aarabi, Bizhan MD; Harris, Mitchel B. MD‡‡; Hurbert, R John MD, PhD§; Rampersaud, Y Raja MD; Vaccaro, Alex MD; Harrop, James S. MD; Nockels, Russ P. MD§§; Madrazo, Ignacio N. MD**; Schwartz, David MD††; Kwon, Brian K. MD, PhD*; Zhao, Yinshan PhD; Fehlings, Michael G. MD, PhD

doi: 10.1097/BRS.0b013e31815cd439
Clinical Case Series

Study Design. A retrospective outcomes study.

Objective. The purposes of this study were 1) to identify plausible patient and interventional variables that influence the outcome of unilateral facet injuries and 2) to determine if patients return to normal general health status after unilateral facet injuries.

Summary of Background Data. The management of unilateral subaxial cervical facet fractures and dislocations lacks agreement on treatment options and the variables that influence outcome.

Methods. Injury data, radiographs, and outcomes (North American Spine Society Cervical Follow-up Questionnaire and Short Form-36) were collected from 9 centers and 13 surgeons, members of the Spine Trauma Study Group.

Results. Causally motor vehicle accidents (49%) and sports (31%) predominated. The C6–C7 level accounted for 60% of injuries and C5–C6 represented 17%. The mean SF-36 PCS score of the operative patients with follow-up >18 months was 6.70 points higher than the mean of the nonoperative patients (P = 0.017). The SF-36 Bodily Pain mean of all patients was 67.2 (SD = 27.6), significantly lower (more pain) than the normative mean of 75.2 (SD = 23.7) (P = 0.014). Nonoperative patients also reported a mean Bodily Pain score of 63.0 (SD = 30.5) that was significantly worse than normative values (P = 0.031). Similarly, the NASS PD mean score for all patients was 84.8 (SD = 17.9), significantly lower than the normative mean of 89.1 (SD = 15.5) (P = 0.014).

Conclusion. To our knowledge this is the largest reported series of facet injuries to date and the only one using health-related quality of life instruments. Unilateral facet injuries of the subaxial cervical spine led to reported levels of pain and disability that are significantly worse than those of the healthy population. Although further study is required, we suggest that nonoperatively treated patients report worse outcomes than operatively treated patients, particularly at longer follow-up despite having a more benign fracture pattern. The presence of comorbidities, associated injuries, and advanced age adversely impact clinical outcomes.

In this retrospective analysis of 90 unilateral facet fractures, nonoperatively treated patients tended to have more pain and disability at follow-up than operative patients despite exhibiting more benign fractures. Following unilateral facet injuries, some pain and disability persist, preventing return to the health status of the normal population.

From the *Division of Spine, Department of Orthopaedics, University of British Columbia and the Combined Neurosurgical and Orthopaedic Spine Program at the Vancouver Hospital and Health Sciences Centre, Vancouver, British Columbia, Canada; †R. Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD; ‡Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; §University of Calgary, Calgary, Alberta, Canada; ∥University Health Network, University of Toronto, Toronto, Ontario, Canada; ¶Department of Orthopaedics and Neurosurgery, Thomas Jefferson University and the Rothman Institute, Philadelphia, PA; ‡‡Department of Neurosurgery, Loyola University Medical Centre, Chicago, IL; **Circuito Fuentes Del Pedregal, Mexico City, Mexico; ††Orthopaedics of Indianapolis, Indianapolis, IN; ‡‡Brigham and Women's Hospital, Department of Orthopaedics, Boston, MA; §Loyola.

Acknowledgment date: January 25, 2007. First revision date: March 20, 2007. Second revision date: April 3, 2007. Acceptance date: April 5, 2007.

Supported by an educational/research grant from Medtronic Sofamor Danek and performed by the Spine Trauma Study Group.

The manuscript submitted does not contain information about medical device(s)/drug(s).

Corporate/Industry funds were received in support of this work. Although one or more of the author(s) has/have received or will receive benefits for personal or professional use from a commercial party related directly or indirectly to the subject of this manuscript, benefits will be directed solely to a research fund, foundation, educational institution, or other nonprofit organization which the author(s) has/have been associated.

Address correspondence and reprint requests to Marcel F. Dvorak, MD, D-609 Heather Pavilion, 2733 Heather Street, Vancouver, BC, Canada V5Z 3J5; E-mail: Marcel.Dvorak@vch.ca

© 2007 Lippincott Williams & Wilkins, Inc.