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Cervical spine injuries associated with lateral mass and facet joint fractures: New classification and surgical treatment with pedicle screw fixation

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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.

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References

  1. Abumi K, Ito H, Taneichi H (1994) Transpedicular screw fixations for traumatic lesions of the middle and lower cervical spine: Description of the techniques and preliminary report. J Spinal Disord 7:19–28

    CAS  PubMed  Google Scholar 

  2. Abumi K, Kaneda K, Shono Y (1999) One-stage posterior decompression and reconstruction of the cervical spine by using pedicle screw fixation systems. J Neurosurg 90:19–26

    CAS  Google Scholar 

  3. Abumi K Shono Y, Kotani Y (2000) Complications of pedicle screw fixation in reconstructive surgery of the cervical spine. Spine 25:962–969

    Article  CAS  PubMed  Google Scholar 

  4. Allen B Jr, Ferguson RL, Lehmann TR (1982) A mechanistic classification of closed, indirect fractures and dislocations of the lower cervical spine. Spine 7:1–27

    PubMed  Google Scholar 

  5. An HS, Coppes MA (1997) Posterior cervical fixation for fracture and degenerative disc disease. Clin Orthop 335:101–111

    PubMed  Google Scholar 

  6. Bohlman HH (1979) Acute fractures and dislocations of the cervical spine: an analysis of three hundred hospitalized patients and review of the literature. J Bone Joint Surg Am 61:1119–1142

    CAS  PubMed  Google Scholar 

  7. Bucholz Rd, Cheung KC (1989) Halo vest versus spinal fusion for cervical injury: Evidence from an outcome study. J Neurosurg 70:884–892

    CAS  PubMed  Google Scholar 

  8. Cooper PR, Cohen A, Rosiello A (1989) Posterior stabilization of cervical spine fractures and subluxations using plates and screws. Neurosurgery 23:300–306

    Google Scholar 

  9. Fehlings GM, Cooper PR, Errico TJ (1994) Posterior plates in the management of cervical instability: long-term results in 44 patients. J Neurosurg 81:341–349

    CAS  PubMed  Google Scholar 

  10. Frankel HL, Hancock DO, Hyslop G (1969) The value of postural reduction in the initial management of closed injuries of the spine with paraplegia and tetraplegia. Paraplegia 7:179–192

    CAS  PubMed  Google Scholar 

  11. Halliday AL, Henderson BR, Hart BL, and Benzel EC (1997) The management of unilateral lateral mass/facet fractures of the subaxial cervical spine. The use of magnetic resonance imaging to predict instability. Spine 22:2614–2621

    CAS  PubMed  Google Scholar 

  12. Harris JH, Mirvis SE (1996) Radiology of acute cervical spine trauma, 3rd edn. Williams & Wilkins, Baltimore, pp 320–339

  13. Heller JG, Silcox DH, Sutterlin CE (1995) Complications of posterior cervical plating. Spine 20:2442–2448

    CAS  PubMed  Google Scholar 

  14. Jeanneret B, Gebhard JS, Magerl F (1994) Transpedicular screw fixation of articular mass fracture-separation: results of an anatomical study and operative technique. J Spinal Disord 7:222–229

    CAS  PubMed  Google Scholar 

  15. Jones EL, Heller JG, Silcox DH, Hutton WC (1997) Cervical pedicle screws versus lateral mass screws: Anatomic feasibility and biomechanical comparison. Spine 22:977–982

    Article  CAS  PubMed  Google Scholar 

  16. Judet R, Roy-Cammile R, Zerah JC (1970) Fracture du rachis cervical, fracture séparation du massif articulaire. Rev Chir Orthop Reparatrice Appar Mot 56:155–164

    CAS  PubMed  Google Scholar 

  17. Kotani Y, Cunnigham BW, Abumi K, McAfee PC (1994) Biomechanical analysis of cervical stabilization systems: An assessment of transpedicular screw fixation in the cervical spine. Spine 19:2529–2539

    CAS  PubMed  Google Scholar 

  18. Levine AM, Mazel C, Roy-Camille R (1992) Management of fracture separations of the articular mass using posterior cervical plating. Spine 17:S447–454

    CAS  PubMed  Google Scholar 

  19. Schultz KD, McLaughlin MR, Haid RW (2000) Single-stage anterior-posterior decompression and stabilization for complex cervical spine disorders. J Neurosurg Spine (2)93:214–221

    Google Scholar 

  20. Shapiro S, Snyder W, Kaufman K (1999) Outcome of 51 cases of unilateral locked cervical facets: interspinous braided cable for lateral mass plate fusion compared with interspinous wire and facet wiring with iliac crest. J Neurosurg Spine (1)91:19–24

    Google Scholar 

  21. Sim E (1995) Vertical facet splitting: a special variant of rotatory dislocations of the cervical spine. J Neurosurg 82:239–243

    CAS  PubMed  Google Scholar 

  22. Smith GR, Beckly DE, Abel MS (1976) Articular mass fracture: A neglected cause of post-traumatic neck pain? Clin Radiol 27:335–340

    CAS  PubMed  Google Scholar 

  23. Whitley JE, Forsyth HF (1960) The classification of cervical spine injuries. Am J Roentgenol Radium Ther Nucl Med 83:633–644

    CAS  PubMed  Google Scholar 

  24. Woodring JH, Lee C (1993) Limitations of cervical radiography in the evaluation of acute cervical trauma. J Trauma 34:32–39

    CAS  PubMed  Google Scholar 

  25. Yetkin Z, Osborn AG, Giles D (1985) Uncovertebral and facet joint dislocations in cervical articular pillar fractures: CT evaluation. AJNR Am J Neuroradiol 6:633–637

    CAS  PubMed  Google Scholar 

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Acknowledgement

The authors acknowledge Masanori Fujiya, M.D., Michinori Saita, M.D., Yasuhiro Shono, M.D., and Takahiro Iida, M.D., for their cooperative work in correction of patient data

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, Kita-15, Nishi-7, Kitaku, 060–8638, Sapporo, Japan

    Yoshihisa Kotani, Kuniyoshi Abumi, Manabu Ito & Akio Minami

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  1. Yoshihisa Kotani
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  2. Kuniyoshi Abumi
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  3. Manabu Ito
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  4. Akio Minami
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Correspondence to Yoshihisa Kotani.

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Kotani, Y., Abumi, K., Ito, M. et al. Cervical spine injuries associated with lateral mass and facet joint fractures: New classification and surgical treatment with pedicle screw fixation. Eur Spine J 14, 69–77 (2005). https://doi.org/10.1007/s00586-004-0793-2

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  • DOI: https://doi.org/10.1007/s00586-004-0793-2

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