Management of unilateral locked facet of the cervical spine

Scott Shapiro, U. Batzdorf, P. R. Cooper

Research output: Contribution to journalArticle

54 Citations (Scopus)

Abstract

TWENTY-FOUR PATIENTS WITH unilateral cervical locked facets were treated between 1986 and 1990. The primary mechanisms of injury were vehicular accidents (58%) and altercations (38%). The level of unilateral facet dislocation was C5-C6 (41%), C6-C7 (25%), C3-C4 (17%), and C4-C5 (17%). Seventeen (70%) came to the hospital with radiculopathy, five (20%) were normal, and two (10%) had spinal cord injuries. Plain films showed subluxation but no fracture. All patients had a cervical computed tomographic scan. Fracture in addition to facet locking was seen in 12 (50%) of 24 scans: 5 with facet fracture, 4 with facet/laminar fractures, 2 with facet/laminar/body fractures, and 1 foramen transversarium fracture. On the basis of CT findings, closed reduction was thought to be contraindicated in two cases. Five patients (22%) underwent successful closed reductions. Two of the patients with closed reductions were placed in a halo but again had subluxation. Thus, 24 patients underwent surgery for open reduction, posterior spinous process wire fixation, and facet wiring to struts of the iliac crest for bony fusion. The initial surgery was successful in 23 (96%) of 24 patients. One patient experienced subluxation and underwent further surgery for anterior cervical fusion/plating. Two wound infections were treated, and there were no deaths or neurological worsening. At 1 year, all deficits had improved. Of 16 radiculopathies, 3 (19%) had persistent 4/5 weakness, and the rest were normal, including 2 delayed-diagnosis patients who both showed improvement from 2/5 to 5/5 strength within 1 week of surgery. Two spinal cord injuries were a central cord injury with persistent bilateral intrinsic hand muscle weakness and a Brown-Sequard injury, initially 1/5, that improved to 4/5 strength. Persistent neck pain was seen in 4 (17%) of 24 cases. A cervical computed tomographic scan provided information that aided in the diagnosis and management. Our experience, along with a review of the literature, strongly suggests that reduction and internal fixation/bony fusion is most successful for this injury.

Original languageEnglish
Pages (from-to)832-837
Number of pages6
JournalNeurosurgery
Volume33
Issue number5
StatePublished - 1993

Fingerprint

Spine
Radiculopathy
Wounds and Injuries
Spinal Cord Injuries
Neck Pain
Delayed Diagnosis
Muscle Weakness
Wound Infection
Motion Pictures
Accidents
Hand

Keywords

  • Cervical spine trauma
  • Internal tixation
  • Locked facet

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Shapiro, S., Batzdorf, U., & Cooper, P. R. (1993). Management of unilateral locked facet of the cervical spine. Neurosurgery, 33(5), 832-837.

Management of unilateral locked facet of the cervical spine. / Shapiro, Scott; Batzdorf, U.; Cooper, P. R.

In: Neurosurgery, Vol. 33, No. 5, 1993, p. 832-837.

Research output: Contribution to journalArticle

Shapiro, S, Batzdorf, U & Cooper, PR 1993, 'Management of unilateral locked facet of the cervical spine', Neurosurgery, vol. 33, no. 5, pp. 832-837.
Shapiro, Scott ; Batzdorf, U. ; Cooper, P. R. / Management of unilateral locked facet of the cervical spine. In: Neurosurgery. 1993 ; Vol. 33, No. 5. pp. 832-837.
@article{c536b8cbeb394141a49fd45526dc4efa,
title = "Management of unilateral locked facet of the cervical spine",
abstract = "TWENTY-FOUR PATIENTS WITH unilateral cervical locked facets were treated between 1986 and 1990. The primary mechanisms of injury were vehicular accidents (58{\%}) and altercations (38{\%}). The level of unilateral facet dislocation was C5-C6 (41{\%}), C6-C7 (25{\%}), C3-C4 (17{\%}), and C4-C5 (17{\%}). Seventeen (70{\%}) came to the hospital with radiculopathy, five (20{\%}) were normal, and two (10{\%}) had spinal cord injuries. Plain films showed subluxation but no fracture. All patients had a cervical computed tomographic scan. Fracture in addition to facet locking was seen in 12 (50{\%}) of 24 scans: 5 with facet fracture, 4 with facet/laminar fractures, 2 with facet/laminar/body fractures, and 1 foramen transversarium fracture. On the basis of CT findings, closed reduction was thought to be contraindicated in two cases. Five patients (22{\%}) underwent successful closed reductions. Two of the patients with closed reductions were placed in a halo but again had subluxation. Thus, 24 patients underwent surgery for open reduction, posterior spinous process wire fixation, and facet wiring to struts of the iliac crest for bony fusion. The initial surgery was successful in 23 (96{\%}) of 24 patients. One patient experienced subluxation and underwent further surgery for anterior cervical fusion/plating. Two wound infections were treated, and there were no deaths or neurological worsening. At 1 year, all deficits had improved. Of 16 radiculopathies, 3 (19{\%}) had persistent 4/5 weakness, and the rest were normal, including 2 delayed-diagnosis patients who both showed improvement from 2/5 to 5/5 strength within 1 week of surgery. Two spinal cord injuries were a central cord injury with persistent bilateral intrinsic hand muscle weakness and a Brown-Sequard injury, initially 1/5, that improved to 4/5 strength. Persistent neck pain was seen in 4 (17{\%}) of 24 cases. A cervical computed tomographic scan provided information that aided in the diagnosis and management. Our experience, along with a review of the literature, strongly suggests that reduction and internal fixation/bony fusion is most successful for this injury.",
keywords = "Cervical spine trauma, Internal tixation, Locked facet",
author = "Scott Shapiro and U. Batzdorf and Cooper, {P. R.}",
year = "1993",
language = "English",
volume = "33",
pages = "832--837",
journal = "Neurosurgery",
issn = "0148-396X",
publisher = "Lippincott Williams and Wilkins",
number = "5",

}

TY - JOUR

T1 - Management of unilateral locked facet of the cervical spine

AU - Shapiro, Scott

AU - Batzdorf, U.

AU - Cooper, P. R.

PY - 1993

Y1 - 1993

N2 - TWENTY-FOUR PATIENTS WITH unilateral cervical locked facets were treated between 1986 and 1990. The primary mechanisms of injury were vehicular accidents (58%) and altercations (38%). The level of unilateral facet dislocation was C5-C6 (41%), C6-C7 (25%), C3-C4 (17%), and C4-C5 (17%). Seventeen (70%) came to the hospital with radiculopathy, five (20%) were normal, and two (10%) had spinal cord injuries. Plain films showed subluxation but no fracture. All patients had a cervical computed tomographic scan. Fracture in addition to facet locking was seen in 12 (50%) of 24 scans: 5 with facet fracture, 4 with facet/laminar fractures, 2 with facet/laminar/body fractures, and 1 foramen transversarium fracture. On the basis of CT findings, closed reduction was thought to be contraindicated in two cases. Five patients (22%) underwent successful closed reductions. Two of the patients with closed reductions were placed in a halo but again had subluxation. Thus, 24 patients underwent surgery for open reduction, posterior spinous process wire fixation, and facet wiring to struts of the iliac crest for bony fusion. The initial surgery was successful in 23 (96%) of 24 patients. One patient experienced subluxation and underwent further surgery for anterior cervical fusion/plating. Two wound infections were treated, and there were no deaths or neurological worsening. At 1 year, all deficits had improved. Of 16 radiculopathies, 3 (19%) had persistent 4/5 weakness, and the rest were normal, including 2 delayed-diagnosis patients who both showed improvement from 2/5 to 5/5 strength within 1 week of surgery. Two spinal cord injuries were a central cord injury with persistent bilateral intrinsic hand muscle weakness and a Brown-Sequard injury, initially 1/5, that improved to 4/5 strength. Persistent neck pain was seen in 4 (17%) of 24 cases. A cervical computed tomographic scan provided information that aided in the diagnosis and management. Our experience, along with a review of the literature, strongly suggests that reduction and internal fixation/bony fusion is most successful for this injury.

AB - TWENTY-FOUR PATIENTS WITH unilateral cervical locked facets were treated between 1986 and 1990. The primary mechanisms of injury were vehicular accidents (58%) and altercations (38%). The level of unilateral facet dislocation was C5-C6 (41%), C6-C7 (25%), C3-C4 (17%), and C4-C5 (17%). Seventeen (70%) came to the hospital with radiculopathy, five (20%) were normal, and two (10%) had spinal cord injuries. Plain films showed subluxation but no fracture. All patients had a cervical computed tomographic scan. Fracture in addition to facet locking was seen in 12 (50%) of 24 scans: 5 with facet fracture, 4 with facet/laminar fractures, 2 with facet/laminar/body fractures, and 1 foramen transversarium fracture. On the basis of CT findings, closed reduction was thought to be contraindicated in two cases. Five patients (22%) underwent successful closed reductions. Two of the patients with closed reductions were placed in a halo but again had subluxation. Thus, 24 patients underwent surgery for open reduction, posterior spinous process wire fixation, and facet wiring to struts of the iliac crest for bony fusion. The initial surgery was successful in 23 (96%) of 24 patients. One patient experienced subluxation and underwent further surgery for anterior cervical fusion/plating. Two wound infections were treated, and there were no deaths or neurological worsening. At 1 year, all deficits had improved. Of 16 radiculopathies, 3 (19%) had persistent 4/5 weakness, and the rest were normal, including 2 delayed-diagnosis patients who both showed improvement from 2/5 to 5/5 strength within 1 week of surgery. Two spinal cord injuries were a central cord injury with persistent bilateral intrinsic hand muscle weakness and a Brown-Sequard injury, initially 1/5, that improved to 4/5 strength. Persistent neck pain was seen in 4 (17%) of 24 cases. A cervical computed tomographic scan provided information that aided in the diagnosis and management. Our experience, along with a review of the literature, strongly suggests that reduction and internal fixation/bony fusion is most successful for this injury.

KW - Cervical spine trauma

KW - Internal tixation

KW - Locked facet

UR - http://www.scopus.com/inward/record.url?scp=0027358509&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0027358509&partnerID=8YFLogxK

M3 - Article

C2 - 8264879

AN - SCOPUS:0027358509

VL - 33

SP - 832

EP - 837

JO - Neurosurgery

JF - Neurosurgery

SN - 0148-396X

IS - 5

ER -