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. 2021 Jun;30(6):1635-1650.
doi: 10.1007/s00586-021-06818-z. Epub 2021 Apr 2.

Variation in global treatment for subaxial cervical spine isolated unilateral facet fractures

Brian A Karamian  1 , Gregory D Schroeder  2 , Martin Holas  3 , Andrei F Joaquim  4 , Jose A Canseco  2 , Shanmuganathan Rajasekaran  5 , Lorin M Benneker  6 , Frank Kandziora  7 , Klaus J Schnake  8 , F Cumhur Öner  9 , Christopher K Kepler  2 , Alexander R Vaccaro  2 ; AO Spine Subaxial Injury Classification System Validation Group
Collaborators, Affiliations
Free article

Variation in global treatment for subaxial cervical spine isolated unilateral facet fractures

Brian A Karamian et al. Eur Spine J. 2021 Jun.
Free article

Abstract

Purpose: To determine the variation in the global treatment practices for subaxial unilateral cervical spine facet fractures based on surgeon experience, practice setting, and surgical subspecialty.

Methods: A survey was sent to 272 members of the AO Spine Subaxial Injury Classification System Validation Group worldwide. Questions surveyed surgeon preferences with regard to diagnostic work-up and treatment of fracture types F1-F3, according to the AO Spine Subaxial Cervical Spine Injury Classification System, with various associated neurologic injuries.

Results: A total of 161 responses were received. Academic surgeons use the facet portion of the AO Spine classification system less frequently (61.6%) compared to hospital-employed and private practice surgeons (81.1% and 81.8%, respectively) (p = 0.029). The overall consensus was in favor of operative treatment for any facet fracture with radicular symptoms (N2) and for any fractures categorized as F2N2 and above. For F3N0 fractures, significantly less surgeons from Africa/Asia/Middle East (49%) and Europe (59.2%) chose operative treatment than from North/Latin/South America (74.1%) (p = 0.025). For F3N1 fractures, significantly less surgeons from Africa/Asia/Middle East (52%) and Europe (63.3%) recommended operative treatment than from North/Latin/South America (84.5%) (p = 0.001). More than 95% of surgeons included CT in their work-up of facet fractures, regardless of the type. No statistically significant differences were seen in the need for MRI to decide treatment.

Conclusion: Considerable agreement exists between surgeon preferences with regard to unilateral facet fracture management with few exceptions. F2N2 fracture subtypes and subtypes with radiculopathy (N2) appear to be the threshold for operative treatment.

Keywords: AO Spine; Global; Imaging; Subaxial; Survey; Treatment; Unilateral facet fracture.

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References

    1. Vaccaro AR et al (2016) AOSpine subaxial cervical spine injury classification system. Eur Spine J 25:2173–2184 - DOI
    1. Schroeder GD et al (2015) A worldwide analysis of the reliability and perceived importance of an injury to the posterior ligamentous complex in AO type A fractures. Global Spine J 5:378–382 - DOI
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    1. Schnake KJ, Schroeder GD, Vaccaro AR, Oner C (2017) AOSpine classification systems (Subaxial, Thoracolumbar). J Orthop Trauma 31:S14–S23 - DOI

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