Maki Satoshi, Kitamura Mitsuhiro, Furuya Takeo, Miyamoto Takuya, Okimatsu Sho, Shiga Yasuhiro, Inage Kazuhide, Orita Sumihisa, Eguchi Yawara, Ohtori Seiji
Department of Orthopaedic Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuou-Ku, Chiba, 260-8670, Japan.
BMC Musculoskelet Disord. 2021 Feb 11;22(1):168. doi: 10.1186/s12891-021-04025-x.
According to most of the commonly used classification systems for subaxial spine injuries, unilateral and minimally displaced facet fractures without any sign of a spinal cord injury would be directed to non-operative management. However, the failure rate of non-operative treatment varies from 20 to 80%, and no consensus exists with regard to predictors of failure after non-operative management.
Case 1 is a patient with a unilateral facet fracture. The patient had only numbness in the right C6 dermatome but failed non-operative treatment, which resulted in severe spinal cord injury. Case 2 is a patient who had a similar injury pattern as case 1 but presented with immediate instability and underwent fusion surgery. Both patients had a minimally displaced unilateral facet fracture accompanied by disc injury and blunt vertebral artery injury, which are possible signs indicating significant instability.
This is the first report of an isolated unilateral facet fracture that resulted in catastrophic spinal cord injury. These two cases illustrate that an isolated minimally displaced unilateral facet fracture with disc injury and vertebral artery injury were associated with significant instability that can lead to spinal cord injury.
根据大多数常用的下颈椎损伤分类系统，单侧且移位极小的关节突骨折若无任何脊髓损伤迹象，应采取非手术治疗。然而，非手术治疗的失败率在20%至80%之间，对于非手术治疗后失败的预测因素尚无共识。
病例1为一名单侧关节突骨折患者。该患者仅右侧C6皮节麻木，但非手术治疗失败，导致严重脊髓损伤。病例2为一名损伤模式与病例1相似的患者，但表现为即刻不稳定并接受了融合手术。两名患者均有移位极小的单侧关节突骨折，伴有椎间盘损伤和椎动脉钝性损伤，这些可能是表明严重不稳定的迹象。
这是首例孤立性单侧关节突骨折导致灾难性脊髓损伤的报告。这两个病例表明，伴有椎间盘损伤和椎动脉损伤的孤立性移位极小的单侧关节突骨折与可导致脊髓损伤的严重不稳定有关。
