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

Scott Shapiro, William Snyder, Kevin Kaufman, Todd Abel

Research output: Contribution to journalArticle

60 Citations (Scopus)

Abstract

Object. To increase knowledge about unilateral facet dislocation, including presentation, radiological findings, management, and outcome, the authors reviewed the cases of 51 consecutive patients with unilateral locked facets of the cervical spine who underwent treatment over an 11-year period. With the development of internal fixation devices, the authors compared the procedure of using interspinous wire and facet wiring of iliac crest to fix unilateral locked facets with that in which interspinous braided cable and lateral mass plates were used. Methods. Thirty-seven patients (73%) presented with radiculopathy, eight (16%) with neck pain only, and six (12%) with spinal cord injuries (SCIs). Plain x-ray films demonstrated subluxation in only 44 (86%) of 51 cases. All patients underwent cervical computerized tomography (CT) scanning, and in all patients with SCI, a magnetic resonance (MR) image was obtained. Fracture in addition to facet locking was seen on 24 (47%) of 51 CT scans. Disc disruption with cord compression was seen in five cases (10%). Based on CT and/or MR imaging findings, a closed reduction procedure was believed to be contraindicated in 11 cases (22%). Of the remaining 40 patients, 13 (33%) underwent closed reduction procedures. Two patients who underwent a closed reduction procedure were placed in a halo brace but experienced resubluxation. Thus, all cases were surgically treated. Forty-six patients underwent posterior reduction and/or internal fixation alone (in 24 cases spinous process fixation with facet wiring was connected to struts of iliac crest, and in 22 cases interspinous braided cable for lateral mass plating was used). Initial surgery, regardless of technique, was successful in 45 (98%) of 46 cases. One patient experienced a resubluxation and underwent reoperation in which anterior cervical fusion and plating were performed. Four of six patients with SCI underwent an emergency combined anterior-posterior decompressive procedure in which internal fixation was performed, and the patients experienced immediate neurological improvement. Overall there were no cases of neurological worsening or death, and there were three cases of wound infection. At 1 year postsurgery, all deficits had improved. Of 37 cases of radiculopathy, three patients (8%) experienced persistent 4/5 weakness, and the remaining patients were normal, including four patients in whom diagnosis was delayed. The six patients with SCI all improved significantly by 1 year. Persistent neck pain was seen in nine cases (18%). Although the lateral mass plates and interspinous cable are stronger, easier to place, and significantly lessened the amount of resultant kyphosis (p < 0.02), the results of chi-square analysis demonstrated only a slight trend for improved clinical outcome compared with the use of wire and iliac crest (p = 0.1). Conclusions. Cervical CT and MR imaging provide information that aids in the diagnosis and management of patients with unilateral locked facets of the cervical spine. The authors' experience strongly suggests that a reduction procedure in which internal fixation and bone fusion are performed will be the most successful treatment for this injury.

Original languageEnglish (US)
Pages (from-to)19-24
Number of pages6
JournalJournal of Neurosurgery
Volume91
Issue number1 SUPPL.
StatePublished - Jul 1 1999
Externally publishedYes

Fingerprint

Spinal Cord Injuries
Tomography
Radiculopathy
Neck Pain
Spine
Internal Fixators
Magnetic Resonance Imaging
Braces
Kyphosis
Delayed Diagnosis
Wound Infection
Motion Pictures
Reoperation
Emergencies
Magnetic Resonance Spectroscopy
X-Rays
Bone and Bones
Wounds and Injuries
Therapeutics

All Science Journal Classification (ASJC) codes

  • Surgery
  • Medicine(all)
  • Clinical Neurology

Cite this

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. / Shapiro, Scott; Snyder, William; Kaufman, Kevin; Abel, Todd.

In: Journal of Neurosurgery, Vol. 91, No. 1 SUPPL., 01.07.1999, p. 19-24.

Research output: Contribution to journalArticle

@article{650d1e49883e4922895a68be2244ddfb,
title = "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",
abstract = "Object. To increase knowledge about unilateral facet dislocation, including presentation, radiological findings, management, and outcome, the authors reviewed the cases of 51 consecutive patients with unilateral locked facets of the cervical spine who underwent treatment over an 11-year period. With the development of internal fixation devices, the authors compared the procedure of using interspinous wire and facet wiring of iliac crest to fix unilateral locked facets with that in which interspinous braided cable and lateral mass plates were used. Methods. Thirty-seven patients (73{\%}) presented with radiculopathy, eight (16{\%}) with neck pain only, and six (12{\%}) with spinal cord injuries (SCIs). Plain x-ray films demonstrated subluxation in only 44 (86{\%}) of 51 cases. All patients underwent cervical computerized tomography (CT) scanning, and in all patients with SCI, a magnetic resonance (MR) image was obtained. Fracture in addition to facet locking was seen on 24 (47{\%}) of 51 CT scans. Disc disruption with cord compression was seen in five cases (10{\%}). Based on CT and/or MR imaging findings, a closed reduction procedure was believed to be contraindicated in 11 cases (22{\%}). Of the remaining 40 patients, 13 (33{\%}) underwent closed reduction procedures. Two patients who underwent a closed reduction procedure were placed in a halo brace but experienced resubluxation. Thus, all cases were surgically treated. Forty-six patients underwent posterior reduction and/or internal fixation alone (in 24 cases spinous process fixation with facet wiring was connected to struts of iliac crest, and in 22 cases interspinous braided cable for lateral mass plating was used). Initial surgery, regardless of technique, was successful in 45 (98{\%}) of 46 cases. One patient experienced a resubluxation and underwent reoperation in which anterior cervical fusion and plating were performed. Four of six patients with SCI underwent an emergency combined anterior-posterior decompressive procedure in which internal fixation was performed, and the patients experienced immediate neurological improvement. Overall there were no cases of neurological worsening or death, and there were three cases of wound infection. At 1 year postsurgery, all deficits had improved. Of 37 cases of radiculopathy, three patients (8{\%}) experienced persistent 4/5 weakness, and the remaining patients were normal, including four patients in whom diagnosis was delayed. The six patients with SCI all improved significantly by 1 year. Persistent neck pain was seen in nine cases (18{\%}). Although the lateral mass plates and interspinous cable are stronger, easier to place, and significantly lessened the amount of resultant kyphosis (p < 0.02), the results of chi-square analysis demonstrated only a slight trend for improved clinical outcome compared with the use of wire and iliac crest (p = 0.1). Conclusions. Cervical CT and MR imaging provide information that aids in the diagnosis and management of patients with unilateral locked facets of the cervical spine. The authors' experience strongly suggests that a reduction procedure in which internal fixation and bone fusion are performed will be the most successful treatment for this injury.",
author = "Scott Shapiro and William Snyder and Kevin Kaufman and Todd Abel",
year = "1999",
month = "7",
day = "1",
language = "English (US)",
volume = "91",
pages = "19--24",
journal = "Journal of Neurosurgery",
issn = "0022-3085",
publisher = "American Association of Neurological Surgeons",
number = "1 SUPPL.",

}

TY - JOUR

T1 - Outcome of 51 cases of unilateral locked cervical facets

T2 - Interspinous braided cable for lateral mass plate fusion compared with interspinous wire and facet wiring with iliac crest

AU - Shapiro, Scott

AU - Snyder, William

AU - Kaufman, Kevin

AU - Abel, Todd

PY - 1999/7/1

Y1 - 1999/7/1

N2 - Object. To increase knowledge about unilateral facet dislocation, including presentation, radiological findings, management, and outcome, the authors reviewed the cases of 51 consecutive patients with unilateral locked facets of the cervical spine who underwent treatment over an 11-year period. With the development of internal fixation devices, the authors compared the procedure of using interspinous wire and facet wiring of iliac crest to fix unilateral locked facets with that in which interspinous braided cable and lateral mass plates were used. Methods. Thirty-seven patients (73%) presented with radiculopathy, eight (16%) with neck pain only, and six (12%) with spinal cord injuries (SCIs). Plain x-ray films demonstrated subluxation in only 44 (86%) of 51 cases. All patients underwent cervical computerized tomography (CT) scanning, and in all patients with SCI, a magnetic resonance (MR) image was obtained. Fracture in addition to facet locking was seen on 24 (47%) of 51 CT scans. Disc disruption with cord compression was seen in five cases (10%). Based on CT and/or MR imaging findings, a closed reduction procedure was believed to be contraindicated in 11 cases (22%). Of the remaining 40 patients, 13 (33%) underwent closed reduction procedures. Two patients who underwent a closed reduction procedure were placed in a halo brace but experienced resubluxation. Thus, all cases were surgically treated. Forty-six patients underwent posterior reduction and/or internal fixation alone (in 24 cases spinous process fixation with facet wiring was connected to struts of iliac crest, and in 22 cases interspinous braided cable for lateral mass plating was used). Initial surgery, regardless of technique, was successful in 45 (98%) of 46 cases. One patient experienced a resubluxation and underwent reoperation in which anterior cervical fusion and plating were performed. Four of six patients with SCI underwent an emergency combined anterior-posterior decompressive procedure in which internal fixation was performed, and the patients experienced immediate neurological improvement. Overall there were no cases of neurological worsening or death, and there were three cases of wound infection. At 1 year postsurgery, all deficits had improved. Of 37 cases of radiculopathy, three patients (8%) experienced persistent 4/5 weakness, and the remaining patients were normal, including four patients in whom diagnosis was delayed. The six patients with SCI all improved significantly by 1 year. Persistent neck pain was seen in nine cases (18%). Although the lateral mass plates and interspinous cable are stronger, easier to place, and significantly lessened the amount of resultant kyphosis (p < 0.02), the results of chi-square analysis demonstrated only a slight trend for improved clinical outcome compared with the use of wire and iliac crest (p = 0.1). Conclusions. Cervical CT and MR imaging provide information that aids in the diagnosis and management of patients with unilateral locked facets of the cervical spine. The authors' experience strongly suggests that a reduction procedure in which internal fixation and bone fusion are performed will be the most successful treatment for this injury.

AB - Object. To increase knowledge about unilateral facet dislocation, including presentation, radiological findings, management, and outcome, the authors reviewed the cases of 51 consecutive patients with unilateral locked facets of the cervical spine who underwent treatment over an 11-year period. With the development of internal fixation devices, the authors compared the procedure of using interspinous wire and facet wiring of iliac crest to fix unilateral locked facets with that in which interspinous braided cable and lateral mass plates were used. Methods. Thirty-seven patients (73%) presented with radiculopathy, eight (16%) with neck pain only, and six (12%) with spinal cord injuries (SCIs). Plain x-ray films demonstrated subluxation in only 44 (86%) of 51 cases. All patients underwent cervical computerized tomography (CT) scanning, and in all patients with SCI, a magnetic resonance (MR) image was obtained. Fracture in addition to facet locking was seen on 24 (47%) of 51 CT scans. Disc disruption with cord compression was seen in five cases (10%). Based on CT and/or MR imaging findings, a closed reduction procedure was believed to be contraindicated in 11 cases (22%). Of the remaining 40 patients, 13 (33%) underwent closed reduction procedures. Two patients who underwent a closed reduction procedure were placed in a halo brace but experienced resubluxation. Thus, all cases were surgically treated. Forty-six patients underwent posterior reduction and/or internal fixation alone (in 24 cases spinous process fixation with facet wiring was connected to struts of iliac crest, and in 22 cases interspinous braided cable for lateral mass plating was used). Initial surgery, regardless of technique, was successful in 45 (98%) of 46 cases. One patient experienced a resubluxation and underwent reoperation in which anterior cervical fusion and plating were performed. Four of six patients with SCI underwent an emergency combined anterior-posterior decompressive procedure in which internal fixation was performed, and the patients experienced immediate neurological improvement. Overall there were no cases of neurological worsening or death, and there were three cases of wound infection. At 1 year postsurgery, all deficits had improved. Of 37 cases of radiculopathy, three patients (8%) experienced persistent 4/5 weakness, and the remaining patients were normal, including four patients in whom diagnosis was delayed. The six patients with SCI all improved significantly by 1 year. Persistent neck pain was seen in nine cases (18%). Although the lateral mass plates and interspinous cable are stronger, easier to place, and significantly lessened the amount of resultant kyphosis (p < 0.02), the results of chi-square analysis demonstrated only a slight trend for improved clinical outcome compared with the use of wire and iliac crest (p = 0.1). Conclusions. Cervical CT and MR imaging provide information that aids in the diagnosis and management of patients with unilateral locked facets of the cervical spine. The authors' experience strongly suggests that a reduction procedure in which internal fixation and bone fusion are performed will be the most successful treatment for this injury.

UR - http://www.scopus.com/inward/record.url?scp=0032701121&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0032701121&partnerID=8YFLogxK

M3 - Article

VL - 91

SP - 19

EP - 24

JO - Journal of Neurosurgery

JF - Journal of Neurosurgery

SN - 0022-3085

IS - 1 SUPPL.

ER -