A prospective randomized controlled trial of anterior compared with posterior stabilization for unilateral facet injuries of the cervical spine
- 1 July 2007
- journal article
- research article
- Published by Journal of Neurosurgery Publishing Group (JNSPG) in Journal of Neurosurgery: Spine
- Vol. 7 (1), 1-12
- https://doi.org/10.3171/spi-07/07/001
Abstract
Unilateral facet injuries can be treated with either anterior or posterior fixation techniques with reportedly good outcomes. The two approaches have not been directly compared, however, and consensus is lacking as to which is the optimal method. The primary objective of this study was to determine whether acute postoperative morbidity differed between anteriorly and posteriorly treated patients with unilateral facet injuries. Forty-two patients were prospectively randomized to undergo either anterior cervical discectomy and fusion or posterior fixation. The primary outcome measure was the postoperative time required to achieve a predefined set of discharge criteria. Secondary outcome measures included postoperative pain, wound infections, radiographically demonstrated fusion and alignment, and patient-reported outcome measures. The median time to achieve the discharge criteria was 2.75 and 3.5 days for anterior and posterior groups, respectively, a difference that did not reach statistical significance (p = 0.096). Compared with those treated using posterior fixation, anteriorly treated patients exhibited somewhat less postoperative pain, a lower rate of wound infection, a higher rate of radiographically demonstrated union, and better radiographically proven alignment. Nonetheless, the anterior approach was accompanied by a risk of swallowing difficulty in the early postoperative period. Patient-reported outcome measures did not reveal a difference between anterior and posterior fixation procedures. This prospective randomized controlled trial provided level 1 evidence that both the anterior and posterior fixation approaches appear to be valid treatment options. Although statistical significance was not reached in the primary outcome measure, some secondary outcome measures favored anterior fixation and others favored posterior treatment for unilateral facet injuries.Keywords
This publication has 32 references indexed in Scilit:
- Fracture dislocations of the cervical spine: a review of 106 conservatively and operatively treated patientsEuropean Spine Journal, 2004
- Kyphotic malalignment after anterior cervical fusion is one of the factors promoting the degenerative process in adjacent intervertebral levelsEuropean Spine Journal, 2001
- The Management of Unilateral Lateral Mass/Facet Fractures of the Subaxial Cervical SpineSpine, 1997
- Management of Unilateral Locked Facet of the Cervical SpineNeurosurgery, 1993
- The use of anterior caspar plate fixation in acute cervical spine injurySurgical Neurology, 1991
- Posterior Wiring Without Bony Fusion in Traumatic Distractive Flexion Injuries of the Mid to Lower Cervical SpineSpine, 1991
- Prediction of stability of cervical spine fracture managed in the halo vest and indications for surgical interventionJournal of Neurosurgery, 1990
- Halo vest versus spinal fusion for cervical injury: evidence from an outcome studyJournal of Neurosurgery, 1989
- Bilateral facet to spinous process fusionNeurosurgery, 1983
- Bilateral Facet to Spinous Process Fusion: A New Technique for Posterior Spinal Fusion after TraumaNeurosurgery, 1983