Totera Juan Ignacio Cirillo, Vargas Gabriel Hernández, Martini Ignacio Farías, Romero Marcos Gimbernat, Bacciarini Alejandro Urzúa, Plaza José Vicente Ballesteros
Division of Spine Surgery, Department of Orthopaedics, Hospital del Trabajador, Santiago, Chile.
Universidad de los Andes, Santiago, Chile.
Asian Spine J. 2023 Feb;17(1):30-36. doi: 10.31616/asj.2021.0437. Epub 2022 Apr 5.
Case-control study.
Analyze association between imaging factors related to the failure of conservative treatment in isolated subaxial cervical facet fractures.
Facet fracture (F1, F2, and F3 AOSpine) may be stable or unstable depending on clinical and imaging variables, which are not well established. As a result, differences in fracture management lead to differences in surgical or conservative indications, and there is no evidence to predict conservative treatment failure.
Patients were categorized into two groups: six patients (16.2%) with conservative treatment failure (defined as the appearance of neurological symptoms, listhesis >3.5 mm, kyphotic deformation >11°, and/or non-union), and 31 patients (83.7%) with successful conservative management (defined as complete consolidation confirmed by computed tomography [CT] at the 6-month followup). All participants were fitted with rigid collars of the Miami type, and standardized follow-up was performed until consolidation or failure. CT and magnetic resonance imaging (MRI) was used to examine imaging characteristics. Sagittal balance parameters were assessed using CT, and signs of acute disc injury, prevertebral edema, facet synovitis, and interspinous hyperintense signal were assessed using MRI.
Thirty-seven patients were diagnosed with unilateral cervical facet fractures between 2009 and 2020. In this sample, acute disc injury had a significative association to failure of conservative treatment in F2 and F3 AOSpine facet fractures, 100% of the failure group presented with traumatic disc injury compared to 9.7% of the successful group, for the other variables: prevertebral edema, 83.7% vs. 41.9%; facet synovitis, 100% vs. 77.4%; and interspinous hyperintensity, 71.4% vs. 38.7%, respectively. With conservative management, all F1 fractures healed successfully. Conservative treatment failed in 20% of F2 fractures and 50% of F3 fractures, respectively. In terms of cervical sagittal balance parameters, there were no significant differences between groups.
Conservative management was successful in all F1 fractures. In F2 and F3 types, there was a significant association between acute disc injury and conservative treatment failure.
病例对照研究。
分析下颈椎孤立性小关节突骨折保守治疗失败相关的影像学因素之间的关联。
小关节突骨折（AOSpine分型的F1、F2和F3）根据临床和影像学变量可能为稳定或不稳定型，而这些变量尚未完全明确。因此，骨折治疗方式的差异导致手术或保守治疗指征的不同，且尚无证据可预测保守治疗失败。
患者分为两组：6例（16.2%）保守治疗失败（定义为出现神经症状、椎体滑脱>3.5mm、后凸畸形>11°和/或骨不连），31例（83.7%）保守治疗成功（定义为6个月随访时经计算机断层扫描[CT]证实完全愈合）。所有参与者均佩戴迈阿密型硬质颈托，并进行标准化随访直至愈合或治疗失败。使用CT和磁共振成像（MRI）检查影像学特征。使用CT评估矢状面平衡参数，使用MRI评估急性椎间盘损伤、椎体前水肿、小关节滑膜炎和棘突间高信号的征象。
2009年至2020年期间，37例患者被诊断为单侧颈椎小关节突骨折。在本样本中，急性椎间盘损伤与AOSpine分型F2和F3小关节突骨折的保守治疗失败有显著关联，失败组100%出现创伤性椎间盘损伤，而成功组为9.7%；其他变量方面：椎体前水肿分别为83.7%和41.9%；小关节滑膜炎分别为100%和77.4%；棘突间高信号分别为71.4%和38.7%。采用保守治疗时，所有F1骨折均成功愈合。F2骨折和F3骨折的保守治疗失败率分别为20%和50%。在颈椎矢状面平衡参数方面，两组之间无显著差异。
所有F1骨折保守治疗均成功。在F2和F3型骨折中，急性椎间盘损伤与保守治疗失败之间存在显著关联。
