Cervical spine injuries associated with lateral mass and facet joint fractures: New classification and surgical treatment with pedicle screw fixation
- 3 November 2004
- journal article
- case report
- Published by Springer Science and Business Media LLC in European Spine Journal
- Vol. 14 (1), 69-77
- https://doi.org/10.1007/s00586-004-0793-2
Abstract
To clarify the injury pattern, initial spinal instability, degree of discoligamentous injuries in cervical lateral mass and facet joint fractures, we retrospectively analyzed radiological parameters and introduced a new classification for these injuries. Surgical treatment was performed with cervical pedicle screw fixation (CPS), and overall neurological and radiological outcome was evaluated with a minimum follow-up period of 2 years. Lateral mass fractures were divided into the following four subtypes: separation, comminution, split, and traumatic spondylolysis. The sagittal and frontal alignments were evaluated at both mainly injured and adjacent spinal segments on radiographs. The initial discoligamentous injuries were investigated on magnetic resonance imaging in terms of their frequencies, subtype of injuries, and involved spinal levels. Anterior translation of fractured vertebra was demonstrated in 77% of lateral mass fractures, while 24% of anterior translation was observed, even in cephalad-adjacent vertebrae. On magnetic resonance imaging, signal changes in anterior longitudinal ligament (ALL) and intervertebral disc were demonstrated in 76% of caudal segments and 24% of cephalad segments adjacent to fractured vertebra of lateral mass fractures. The subtype analyses of lateral mass fractures demonstrated high rates of anterior translation in separation, split, and traumatic spondylolisthesis, as well as significant coronal malalignment in comminution and split types (p<0.05). Thirty-one patients underwent surgical treatments using a cervical pedicle screw fixation. The CPS provided the superior capability of deformity correction without pseudoarthrosis, as well as excellent neurological recovery. The average numbers of stabilized segments were minimized without serious complications. In separation, facet joint fracture, and fractures with mild lateral mass comminution, the single level posterior fixation can be considered. The significant unstable injuries of split and comminution type with coronal malalignment can be treated with exclusive two-level posterior stabilization with CPS. The initial evaluation of fracture subtypes helps to successfully minimize the stabilized spinal segment.Keywords
This publication has 26 references indexed in Scilit:
- The Management of Unilateral Lateral Mass/Facet Fractures of the Subaxial Cervical SpineSpine, 1997
- Tuberculosis of the Long Bone in ChildrenClinical Orthopaedics and Related Research, 1997
- Complications of Posterior Cervical PlatingSpine, 1995
- Vertical facet splitting: a special variant of rotary dislocations of the cervical spineJournal of Neurosurgery, 1995
- Posterior plates in the management of cervical instability: long-term results in 44 patientsJournal of Neurosurgery, 1994
- LIMITATIONS OF CERVICAL RADIOGRAPHY IN THE EVALUATION OF ACUTE CERVICAL TRAUMAThe Journal of Trauma and Acute Care Surgery, 1993
- Halo vest versus spinal fusion for cervical injury: evidence from an outcome studyJournal of Neurosurgery, 1989
- Posterior Stabilization of Cervical Spine Fractures and Subluxations Using Plates and ScrewsNeurosurgery, 1988
- A Mechanistic Classification of Closed, Indirect Fractures and Dislocations of the Lower Cervical SpineSpine, 1982
- The value of postural reduction in the initial management of closed injuries of the spine with paraplegia and tetraplegiaSpinal Cord, 1969