Kong Chae-Gwan, Park Jong-Beom
Department of Orthopaedic Surgery, Uijeongbu St. Mary's Hospital, The Catholic University of Korea College of Medicine, Uijeongbu 11765, Republic of Korea.
J Clin Med. 2025 Apr 8;14(8):2554. doi: 10.3390/jcm14082554.
Minimal facet and lateral mass fractures of the subaxial cervical spine (C3-C7) are a distinct subset of spinal injuries that present diagnostic and therapeutic challenges. These fractures often result from low-energy trauma or hyperextension mechanisms. They are frequently stable. However, subtle fracture instability and associated soft tissue injuries may lead to delayed instability, neurological compromise, and/or chronic severe pain if not properly identified. Accurate diagnosis relies on a combination of plain radiography, high-resolution computed tomography (CT), and magnetic resonance imaging (MRI) to assess bony and ligamentous integrity. Treatment strategy is determined based on fracture stability, neurological status, and radiographic findings. Most stable fractures can be effectively treated with conservative treatment, allowing for natural healing while minimizing complications. However, when instability is suspected-such as those with significant disc and ligamentous injuries, progressive deformity, or neurological deficits-surgical stabilization may be considered. The presence of vertebral artery injury (VAI) can further complicate management. To mitigate the risk of stroke, a multidisciplinary approach that includes neurosurgery, vascular surgery, and interventional radiology is needed. Surgical treatment aims to restore spinal alignment, maintain stability, and prevent further neurological deterioration with approaches tailored to individual fracture patterns and patient-specific factors. Advances in surgical techniques, perioperative management, and endovascular interventions for VAI continue refining treatment options to improve clinical outcomes while minimizing complications. Despite increasing knowledge of these fractures and associated vascular injuries, optimal treatment strategies remain unclear due to limited high-quality evidence. This review provides a comprehensive analysis of the anatomy, biomechanics, classification, imaging modalities, and treatment strategies for minimal facet and lateral mass fractures in the subaxial cervical spine, highlighting recent advancements in diagnostic tools, therapeutic approaches, and managing vertebral artery injuries. A more precise understanding of the natural history and optimal management of these injuries will help spine specialists refine clinical decision-making and improve patient outcomes.
下颈椎（C3 - C7）的微小关节突和侧块骨折是脊柱损伤中的一个独特子集，带来了诊断和治疗方面的挑战。这些骨折通常由低能量创伤或过伸机制导致。它们常常是稳定的。然而，如果未得到正确识别，细微的骨折不稳定性及相关软组织损伤可能导致延迟性不稳定、神经功能损害和/或慢性剧痛。准确诊断依赖于X线平片、高分辨率计算机断层扫描（CT）和磁共振成像（MRI）相结合，以评估骨骼和韧带的完整性。治疗策略根据骨折稳定性、神经状态和影像学表现来确定。大多数稳定骨折可通过保守治疗有效处理，促进自然愈合同时将并发症降至最低。然而，当怀疑存在不稳定性时，如伴有严重椎间盘和韧带损伤、进行性畸形或神经功能缺损的情况，可能需要考虑手术稳定治疗。椎动脉损伤（VAI）的存在会使治疗更加复杂。为降低中风风险，需要一种包括神经外科、血管外科和介入放射学的多学科方法。手术治疗旨在恢复脊柱对线、维持稳定性并防止神经功能进一步恶化，采用针对个体骨折类型和患者特定因素的方法。手术技术、围手术期管理以及VAI的血管内介入治疗方面的进展不断完善治疗选择，以改善临床结果同时减少并发症。尽管对这些骨折及相关血管损伤的认识不断增加，但由于高质量证据有限，最佳治疗策略仍不明确。本综述对下颈椎微小关节突和侧块骨折的解剖学、生物力学、分类、成像方式及治疗策略进行了全面分析，突出了诊断工具、治疗方法以及椎动脉损伤管理方面的最新进展。对这些损伤的自然病程和最佳管理有更精确的理解将有助于脊柱专科医生优化临床决策并改善患者预后。
