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. 2017 Apr;7(2):110-115.
doi: 10.1177/2192568217694002. Epub 2017 Apr 6.

Traumatic Cervical Unilateral and Bilateral Facet Dislocations Treated With Anterior Cervical Discectomy and Fusion Has a Low Failure Rate

Alireza K Anissipour  1 , Julie Agel  1 , Matthew Baron  1 , Erik Magnusson  1 , Carlo Bellabarba  1 , Richard J Bransford  1
Affiliations

Traumatic Cervical Unilateral and Bilateral Facet Dislocations Treated With Anterior Cervical Discectomy and Fusion Has a Low Failure Rate

Alireza K Anissipour et al. Global Spine J. 2017 Apr.

Abstract

Study design: Retrospective radiographic and chart review.

Objective: To define the rate and associated risk factors of treatment failure of anterior cervical fusion for treatment of cervical facet dislocations.

Methods: Between 2004 and 2014, a retrospective review at a single level 1 trauma center identified 38 patients with unilateral or bilateral dislocated facet(s) treated with anterior cervical discectomy and fusion (ACDF). Two patients were eliminated due to less than 30-day follow-up. Demographic data, initial neurological exams, surgical data, radiographic findings, and follow-up records were reviewed.

Results: Of the 36 patients with facet dislocations treated with ACDF using a fixed locking plate, 16 were unilateral and 20 were bilateral. The mean age was 35 years (range 13-58). Mean follow-up was 323 days (range 30-1998). There were 3 treatment failures (8%). Three of 7 (43%) endplate fractures failed (P < .01), and 1/28 (4%) facet fractures failed (P = .13). The mean time to failure was 4 weeks (1-7 weeks). One treatment failure had a facet fracture, and all 3 failures had an associated endplate fracture.

Conclusion: Treatment failure occurred in 3 out of 36 (8%) patients with facet fracture dislocations treated with anterior cervical discectomy, fusion, and plating. Rates of failure are lower than has been previously reported. Endplate fractures of the inferior level in jumped facets appears to be a major risk factor of biomechanical failure. However, a facet fracture may not be a risk factor for failure. In the absence of an endplate fracture, ACDF is a reasonable treatment option in patients with single-level cervical facet dislocation.

Keywords: ACDF; cervical dislocation; facet; facet dislocation; facet fracture; jumped facets; perched.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Richard J. Bransford reports personal fees from AOSpine North America, personal fees from Globus, grants from Depuy-Synthes, outside the submitted work.

Figures

Figure 1.
Figure 1.
Measurement taken to record translation. (Note that the screws in this failure are relatively short and did not measure to be within 2 mm of the posterior cortex of the vertebral body.)
Figure 2.
Figure 2.
Measurement taken to record kyphosis.
Figure 3.
Figure 3.
(A) Preoperative mid-sagittal CT reformat showing kyphosis and translation at C5-C6 with subtle endplate fracture at C6 in 36-year-old male alcoholic who fell down the stairs. (B) Preoperative para-sagittal CT reformat showing perched facet on left. (C) Immediate postoperative lateral cervical spine radiograph. (D) Four-week postoperative radiograph showing increased kyphosis. (E) Six-month follow-up lateral radiograph after posterior lateral mass screws placed bilaterally at C5-C6.
See this image and copyright information in PMC

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