Failure of conservative treatment in cervical facet fractures: The impact of disc rupture in a retrospective series.

INTRODUCTION

Cervical facet injuries pose a complex clinical challenge. Management strategies and prognosis remain under debate in the literature. This study aims to describe a series of cases to identify factors that facilitate decision-making in the management and prognosis of these fractures.

METHODS

A retrospective study of patients with unilateral cervical facet fractures (F2 or F3, AO Spine classification) was conducted at a single trauma center. The study included 46 males and 4 females aged 21-65 years. All patients underwent initial spine CT scans, radiographs and MRI. Management was based on fracture stability and clinical presentation. Patients were categorized into F2/F3 groups and further subdivided based on initial management: orthopedic, emergency surgery (kyphosis >11°, listhesis >3.5mm, or neurological compromise), and planned surgery. Follow-up included imaging studies and specialist consultation. In cases where conservative management failed, surgery was performed.

RESULTS

Fifty patients were diagnosed with cervical facet fractures, with the C6-C7 segment being the most commonly affected (53.06%). Nine patients required emergency surgery, all had disc injury, and 7 (77.7%) presented with listhesis >2mm. Among patients receiving orthopedic management, 7 (25%) experienced treatment failure, all of whom exhibited disc injury, facet synovitis, and prevertebral edema. The success rate for conservative treatment differed between groups: 84.2% in the F2 group and 55.5% in the F3 group. No patient exhibited persistent neurological deficits at follow-up.

CONCLUSION

The presence of disc lesions and facet synovitis significantly influences treatment outcomes, underlining the need for tailored approaches to optimize patient care.