Abstract
Introduction The management of cervical spine facet fractures, dislocations and subluxations in the literature is controversial. Many implants have been tested biomechanically and clinically. The overall biomechanical evidence points to greater stability with posterior constructs, however anterior surgery has practical advantages in terms of less dissection and local trauma than the posterior approach. The aim of this audit was to assess radiological results of facet joint fracture dislocations treated between January 2000 and August 2004. The audit was designed to examine the hypothesis that anterior fixation is inferior to posterior or combined anterior and posterior fixation.
Methods The clinical notes and radiological images of patients who present with a uni- or bifacet fracture dislocation during the study period were retrospectively reviewed. There were 21 patients treated during this period. 4 patients had incomplete radiological follow-up and were excluded. 12 Patients underwent anterior procedures, 3 posterior and 2 combined. Radiological follow-up included analysis of post-operative and final follow up x-rays. Failures were defined as evidence of nonunion, failure of metal ware, persisting kyphosis greater than 11 degrees or change in translation greater than 4 mm. Complications noted were 2 superficial infections, 1 psuedarthrosis 1 aspiration pneumonia, 1 ileus.
Results Overall 1 patient receiving anterior surgery developed a pseudarthrosis. This patient went on to develop fusion with posterior wiring and graft. Two patients developed wound infections following posterior wiring. All patients developed radiological fusion. Statistically there was no difference in radiological failure between anterior, posterior or combined anterior and posterior fusion.
Discussion There is insufficient evidence to reject the null hypothesis, anterior plating is inferior to posterior wiring or combined anterior and posterior procedures, and neither can the alternative be accepted. Better biomechanical results have been reported for posterior instrumentations and some authors have reported high rates of radiological failure with anterior fixation. However the anterior approach is associated with fewer complications in the literature6. The complicated nature of the facet fracture and the accompanying ligament injuries require patients to be assessed on an individual basis and treated as such.
The abstracts were prepared by Assoc Prof Bruce McPhee. Correspondence should be addressed to him at the Division of Orthopaedics, The University of Queensland, Clinical Sciences Building, Royal Brisbane Hospital, Herston, Brisbane, 4029, Australia.
