The classifications of subaxial cervical spine traumatic injuries. Part 5. Facet joint and lateral mass lesions
Keywords:traumatic injury, classification, cervical spine, subaxial level, lateral masses, facet joints
Traumatic injury to the cervical spine accompanied by a wide range of possible changes in its osteo-ligamentous apparatus. One of the basic criteria to determine the treatment strategy is the assessment of injury stability which depends on the condition of the spine supporting columns. Most of the modern and widely used classifications of subaxial cervical spine traumatic injuries quite sufficiently characterize the state of the anterior support column. At the same time, much less attention is paid to the assessment of the degree and nature of traumatic changes in lateral masses, facet joints, as well as possible dislocations.
Literature analysis reveals the absence of a generally accepted scheme that would allow one to unambiguously and comprehensively characterize the damage to the facets / lateral masses and choose the optimal surgical or conservative treatment method. This review provides well known assessment schemes: classification of traumatic changes of facet joints by Marcel F. Dvorak et al., variants of traumatic displacement of the cervical vertebrae by V.P. Selivanov, variants of lateral mass traumatic injury by Y. Kotani et al. and Posterior Ligament-Bone Injury Classification and Severity Score.
The advantages and disadvantages of anterior, posterior or combined approach for the treatment of traumatic injuries of posterior support complex are considered that is of critical importance for obtaining better clinical results. It is noted that the choice of the optimal treatment method is currently a controversial issue. Although good surgical results can be obtained using a variety of methods, there are certain situations in which one technique may be better than others. The accumulated clinical experience and current research on the injured spine biomechanics demonstrate the advantage of surgical treatment in most patients, since such injuries are usually unstable or potentially unstable.
2. Lenehan B, Boran S, Street J, Higgins T, McCormack D, Poynton AR. Demographics of acute admissions to a National Spinal Injuries Unit. Eur Spine J. 2009 Jul;18(7):938-42. [CrossRef] [PubMed] [PubMed Central]
3. Rosinczuk-Tonderys J, Zaluski R, Gdesz M, Lisowska A. Spine and spinal cord injuries--causes and complications. Adv Clin Exp Med. 2012;21(4):477-485. [PubMed]
4. Varma A, Hill EG, Nicholas J, Selassie A. Predictors of early mortality after traumatic spinal cord injury: a population-based study. Spine (Phila Pa 1976). 2010 Apr 1;35(7):778-83. [CrossRef] [PubMed]
5. Yue JK, Winkler EA, Rick JW, Deng H, Partow CP, Upadhyayula PS, Birk HS, Chan AK, Dhall SS. Update on critical care for acute spinal cord injury in the setting of polytrauma. Neurosurg Focus. 2017 Nov;43(5):E19. [CrossRef] [PubMed]
6. Passias PG, Poorman GW, Segreto FA, Jalai CM, Horn SR, Bortz CA, Vasquez-Montes D, Diebo BG, Vira S, Bono OJ, De La Garza-Ramos R, Moon JY, Wang C, Hirsch BP, Zhou PL, Gerling M, Koller H, Lafage V. Traumatic Fractures of the Cervical Spine: Analysis of Changes in Incidence, Cause, Concurrent Injuries, and Complications Among 488,262 Patients from 2005 to 2013. World Neurosurg. 2018 Feb;110:e427-e437. [CrossRef] [PubMed]
7. Fehlings MG, Noonan VK, Atkins D, Burns AS, Cheng CL, Singh A, Dvorak MF. Optimizing Clinical Decision Making in Acute Traumatic Spinal Cord Injury. J Neurotrauma. 2017 Oct 15;34(20):2841-2842. [CrossRef] [PubMed] [PubMed Central]
8. Paquet J, Rivers CS, Kurban D, Finkelstein J, Tee JW, Noonan VK, Kwon BK, Hurlbert RJ, Christie S, Tsai EC, Ahn H, Drew B, Bailey CS, Fourney DR, Attabib N, Johnson MG, Fehlings MG, Parent S, Dvorak MF; RHSCIR Network. The impact of spine stability on cervical spinal cord injury with respect to demographics, management, and outcome: a prospective cohort from a national spinal cord injury registry. Spine J. 2018 Jan;18(1):88-98. [CrossRef] [PubMed]
11. Watson-Jones R. Fracture and Joint Injuries. 3rd ed. Baltimore: Williams & Wilkins; 1943.
12. Nicoll EA. Fractures of the dorso-lumbar spine. J Bone Joint Surg Br. 1949;31B(3):376-394. [PubMed]
14. White AA, Southwick WO, Panjabi MM. Clinical Instability in the Lower Cervical Spine A Review of Past and Current Concepts. Spine. 1976;1.
15. White AA, 3rd, Panjabi MM. Update on the evaluation of instability of the lower cervical spine. Instr Course Lect. 1987;36:513-520. [PubMed]
23. Roy-Camille R. Rachis cervical traumatique non neurologique. Paris,: Masson; 1979. 195 p.
25. Gertzbein SD, Seligman J, Holtby R, Chan KW, Ogston N, Kapasouri A, Tile M. Centrode characteristics of the lumbar spine as a function of segmental instability. Clin Orthop Relat Res. 1986 Jul;(208):48-51. [CrossRef] [PubMed]
27. Gertzbein SD, Seligman J, Holtby R, Chan KH, Kapasouri A, Tile M, Cruickshank B. Centrode patterns and segmental instability in degenerative disc disease. Spine (Phila Pa 1976). 1985 Apr;10(3):257-61. [CrossRef] [PubMed]
28. Su Q, Li C, Li Y, Zhou Z, Zhang S, Guo S, Feng X, Yan M, Zhang Y, Zhang J, Pan J, Cheng B, Tan J. Analysis and improvement of the three-column spinal theory. BMC Musculoskelet Disord. 2020 Aug 12;21(1):537. [CrossRef] [PubMed] [PubMed Central]
29. Vaccaro AR, Koerner JD, Radcliff KE, Oner FC, Reinhold M, Schnake KJ, Kandziora F, Fehlings MG, Dvorak MF, Aarabi B, Rajasekaran S, Schroeder GD, Kepler CK, Vialle LR. AOSpine subaxial cervical spine injury classification system. Eur Spine J. 2016 Jul;25(7):2173-84. [CrossRef] [PubMed]
30. Dvorak MF, Fisher CG, Aarabi B, Harris MB, Hurbert RJ, Rampersaud YR, Vaccaro A, Harrop JS, Nockels RP, Madrazo IN, Schwartz D, Kwon BK, Zhao Y, Fehlings MG. Clinical outcomes of 90 isolated unilateral facet fractures, subluxations, and dislocations treated surgically and nonoperatively. Spine (Phila Pa 1976). 2007 Dec 15;32(26):3007-13. [CrossRef] [PubMed]
31. Andreshak JL, Dekutoski MB. Management of unilateral facet dislocations: a review of the literature. Orthopedics. 1997;20(10):917-926. [PubMed]
32. Bono CM, Vaccaro AR, Fehlings M, Fisher C, Dvorak M, Ludwig S, Harrop J. Measurement techniques for lower cervical spine injuries: consensus statement of the Spine Trauma Study Group. Spine (Phila Pa 1976). 2006 Mar 1;31(5):603-9. [CrossRef] [PubMed]
33. van Middendorp JJ, Cheung I, Dalzell K, Deverall H, Freeman BJ, Morris SA, Sandler SJ, Williams R, Yau YH, Goss B. Detecting Facet Joint and Lateral Mass Injuries of the Subaxial Cervical Spine in Major Trauma Patients. Asian Spine J. 2015 Jun;9(3):327-37. [CrossRef] [PubMed] [PubMed Central]
35. Gelehrter G. Risse des vorderen Längsbandes im Bereiche der Halswirbelsäule [Rupture of anterior longitudinal ligament of the cervical spine]. Arch Orthop Unfallchir. 1957;48(6):698-704. German. [CrossRef] [PubMed]
36. Selivanov VP, Nikitin MN. Diagnostika i lechenie vyvikhov sheynykh pozvonkov. Moscow: Meditsina; 1971. 327 p. Russian.
37. Selivanov VP. Profilaktika oslozhneniy pri vpravlenii travmaticheskikh smeshcheniy sheynykh pozvonkov. Khirurgiya. 1970;(9):51-60. Russian.
39. Allen BL Jr, Ferguson RL, Lehmann TR, O’Brien RP. A mechanistic classification of closed, indirect fractures and dislocations of the lower cervical spine. Spine (Phila Pa 1976). 1982 Jan-Feb;7(1):1-27. [CrossRef] [PubMed]
41. van Eck CF, Fourman MS, Abtahi AM, Alarcon L, Donaldson WF, Lee JY. Risk Factors for Failure of Nonoperative Treatment for Unilateral Cervical Facet Fractures. Asian Spine J. 2017;11(3):356-364. [CrossRef] [PubMed]
42. Maki S, Kitamura M, Furuya T, Miyamoto T, Okimatsu S, Shiga Y, Inage K, Orita S, Eguchi Y, Ohtori S. Minimally displaced unilateral facet fracture of cervical spine can lead to spinal cord injury: a report of two cases. BMC Musculoskelet Disord. 2021 Feb 11;22(1):168. [CrossRef] [PubMed] [PubMed Central]
44. Lee SH, Sung JK. Unilateral lateral mass-facet fractures with rotational instability: new classification and a review of 39 cases treated conservatively and with single segment anterior fusion. J Trauma. 2009;66(3):758-767. [CrossRef] [PubMed]
45. Rabb CH, Lopez J, Beauchamp K, Witt P, Bolles G, Dwyer A. Unilateral cervical facet fractures with subluxation: injury patterns and treatment. J Spinal Disord Tech. 2007;20(6):416-422. [CrossRef] [PubMed]
47. Kotani Y, Abumi K, Ito M, Minami A. Cervical spine injuries associated with lateral mass and facet joint fractures: new classification and surgical treatment with pedicle screw fixation. Eur Spine J. 2005;14(1):69-77. [CrossRef] [PubMed]
48. Yang JS, Liu P, Liu TJ, Zhang HP, Zhang ZP, Yan L, Zhao QP, He BR, Tuo Y, Zhao YT, Huang DG, Hao DJ. Posterior Ligament-Bone Injury Classification and Severity Score: A Novel Approach to Predict the Failure of Anterior-only Surgery for Subaxial Cervical Facet Dislocations. Spine (Phila Pa 1976). 2021 Feb 15;46(4):209-215. [CrossRef] [PubMed]
49. Blake LC, Cohen WA, Maravilla KR. Detection of ligamentous and supporting soft tissue injuries using fat-suppressed MRI in acute spinal trauma. In. Proceedings of the XV Symposium Neuroradiologicum. Springer Berlin Heidelberg; 1995;314–6. [CrossRef]
51. Yang JS, Liu P, Liu TJ, Zhang HP, Zhang ZP, Yan L, Tuo Y, Chen H, Zou P, Li QD, Zhao YT, Hao DJ. When is the circumferential stabilization necessary for subaxial cervical fracture dislocations? The posterior ligament-bone injury classification and severity score: a novel treatment algorithm. Eur Spine J. 2021 Feb;30(2):524-533. [CrossRef] [PubMed]
52. Heyde CE, Fakler JK, Hasenboehler E, Stahel PF, John T, Robinson Y, Tschoeke SK, Kayser R. Pitfalls and complications in the treatment of cervical spine fractures in patients with ankylosing spondylitis. Patient Saf Surg. 2008 Jun 6;2:15. [CrossRef] [PubMed] [PubMed Central]
54. Fehlings MG, Vaccaro A, Wilson JR, Singh A, W Cadotte D, Harrop JS, Aarabi B, Shaffrey C, Dvorak M, Fisher C, Arnold P, Massicotte EM, Lewis S, Rampersaud R. Early versus delayed decompression for traumatic cervical spinal cord injury: results of the Surgical Timing in Acute Spinal Cord Injury Study (STASCIS). PLoS One. 2012;7(2):e32037. [CrossRef] [PubMed] [PubMed Central]
55. Del Curto D, Tamaoki MJ, Martins DE, Puertas EB, Belloti JC. Surgical approaches for cervical spine facet dislocations in adults. Cochrane Database Syst Rev. 2014 Oct 30;2014(10):CD008129. [CrossRef] [PubMed] [PubMed Central]
57. Nakashima H, Yukawa Y, Ito K, Machino M, El Zahlawy H, Kato F. Posterior approach for cervical fracture-dislocations with traumatic disc herniation. Eur Spine J. 2011;20(3):387-394. [CrossRef] [PubMed]
58. Kwon BK, Fisher CG, Boyd MC, Cobb J, Jebson H, Noonan V, Wing P, Dvorak MF. A prospective randomized controlled trial of anterior compared with posterior stabilization for unilateral facet injuries of the cervical spine. J Neurosurg Spine. 2007 Jul;7(1):1-12. [CrossRef] [PubMed]
62. Rorabeck CH, Rock MG, Hawkins RJ, Bourne RB. Unilateral facet dislocation of the cervical spine. An analysis of the results of treatment in 26 patients. Spine (Phila Pa 1976). 1987;12(1):23-27. [CrossRef] [PubMed]
65. Halani SH, Baum GR, Riley JP, Pradilla G, Refai D, Rodts GE Jr, Ahmad FU. Esophageal perforation after anterior cervical spine surgery: a systematic review of the literature. J Neurosurg Spine. 2016 Sep;25(3):285-91. [CrossRef] [PubMed]
66. Johnson MG, Fisher CG, Boyd M, Pitzen T, Oxland TR, Dvorak MF. The radiographic failure of single segment anterior cervical plate fixation in traumatic cervical flexion distraction injuries. Spine (Phila Pa 1976). 2004;29(24):2815-2820. [CrossRef] [PubMed]
67. Dvorak MF, Fisher CG, Fehlings MG, Rampersaud YR, Oner FC, Aarabi B, Vaccaro AR. The surgical approach to subaxial cervical spine injuries: an evidence-based algorithm based on the SLIC classification system. Spine (Phila Pa 1976). 2007 Nov 1;32(23):2620-9. [CrossRef] [PubMed]
68. Duggal N, Chamberlain RH, Park SC, Sonntag VK, Dickman CA, Crawford NR. Unilateral cervical facet dislocation: biomechanics of fixation. Spine (Phila Pa 1976). 2005;30(7):E164-168. [CrossRef] [PubMed]
69. Radcliff KE, Koyonos L, Clyde C, Sidhu GS, Fickes M, Hilibrand AS, Albert TJ, Vaccaro AR, Rihn JA. What is the incidence of dysphagia after posterior cervical surgery? Spine (Phila Pa 1976). 2013 Jun 1;38(13):1082-8. [CrossRef] [PubMed]
70. Bydon M, Macki M, Kaloostian P, Sciubba DM, Wolinsky JP, Gokaslan ZL, Belzberg AJ, Bydon A, Witham TF. Incidence and prognostic factors of c5 palsy: a clinical study of 1001 cases and review of the literature. Neurosurgery. 2014 Jun;74(6):595-604; discussion 604-5. [CrossRef] [PubMed]
72. Abumi K, Shono Y, Kotani Y, Kaneda K. Indirect posterior reduction and fusion of the traumatic herniated disc by using a cervical pedicle screw system. J Neurosurg. 2000;92(1 Suppl):30-37. [CrossRef] [PubMed]
78. Han Y, Ma XL, Hu YC, Miao J, Zhang JD, Bai JQ, Xia Q. Circumferential Reconstruction of Subaxial Cervical and Cervicothoracic Spine by Simultaneously Combined Anterior-posterior Approaches in the Sitting Position. Orthop Surg. 2017 Aug;9(3):263-270. [CrossRef] [PubMed] [PubMed Central]
79. Song KJ, Lee KB. Anterior versus combined anterior and posterior fixation/fusion in the treatment of distraction-flexion injury in the lower cervical spine. J Clin Neurosci. 2008;15(1):36-42. [CrossRef] [PubMed]
How to Cite
Copyright (c) 2021 O. S. Nekhlopochyn, I. I. Slynko, V. V. Verbov
This work is licensed under a Creative Commons Attribution 4.0 International License.
Ukrainian Neurosurgical Journal abides by the CREATIVE COMMONS copyright rights and permissions for open access journals.
Authors, who are published in this Journal, agree to the following conditions:
1. The authors reserve the right to authorship of the work and pass the first publication right of this work to the Journal under the terms of Creative Commons Attribution License, which allows others to freely distribute the published research with the obligatory reference to the authors of the original work and the first publication of the work in this Journal.
2. The authors have the right to conclude separate supplement agreements that relate to non-exclusive work distribution in the form of which it has been published by the Journal (for example, to upload the work to the online storage of the Journal or publish it as part of a monograph), provided that the reference to the first publication of the work in this Journal is included.