Risk Factors for Failure of Nonoperative Treatment for Unilateral Cervical Facet Fractures

Carola Francisca van Eck; Mitchell Stephen Fourman; Amir Mohamad Abtahi; Louis Alarcon; William Fielding Donaldson; Joon Yung Lee

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자료유형: 학술저널

저자정보: Carola Francisca van Eck (University of Pittsburgh) Mitchell Stephen Fourman (University of Pittsburgh) Amir Mohamad Abtahi (University of Pittsburgh) Louis Alarcon (University of Pittsburgh) William Fielding Donaldson (University of Pittsburgh) Joon Yung Lee (University of Pittsburgh)

저널정보: 대한척추외과학회 Asian Spine Journal Asian Spine Journal Vol.11 No.3

발행연도: 2017.1

수록면: 356 - 364 (9page)

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Study Design: Retrospective clinical study. Purpose: The purpose of this study was to determine what percentage of patients who underwent nonoperative management of unilateral non-displaced or minimally displaced facet fractures progressed radiographically and to determine what percentage of patients required surgical intervention and to identify risk factors for failure of conservative management. Overview of Literature: According to most commonly used classification systems, unilateral, non-and minimally displaced facet fractures are be amendable to nonoperative management. Methods: A retrospective review of the Trauma Registry of a Level I trauma center was performed to identify all patients diagnosed with a non- or minimally displaced unilateral facet fracture which was managed nonoperatively. Several demographic variables and clinical outcomes were recorded. Using computed tomography scanning and plain radiographs, fracture pattern, listhesis, displacement, angle and percentage of the facet that included the fracture were determined. Radiographic progression was defined as the occurrence of listhesis of more than 10% of the anterior-posterior dimensions of the inferior vertebral body during radiographic follow-up. Failure of conservative management was defined as a patient requiring surgical intervention after initially being managed nonoperatively. Results: Seventy-four patients were included. Fifteen patients (20%) progressed radiographically. However, only 2 developed radicular symptoms and none developed myelopathy or other catastrophic cord related symptoms. Seven patients (9%) underwent surgery. Indications for surgery included significant radiographic progression and/or radicular symptoms. Risk factors for failure of conservative management included presence of radiculopathy at the time of presentation, a higher body mass index, increased Injury Severity Score, greater initial fracture displacement and more than 2 mm of listhesis. Conclusions: Patients with non-displaced or minimally displaced facet fractures who do not have neurological symptoms at the time of presentation can safely be managed conservatively with careful observation and follow-up.

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참고문헌 신청

Delcourt T / 2015 / Management of upper cervical spine fractures in elderly patients: current trends and outcomes / Injury 46(Suppl 1):S24~S27

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