Articular process fracture
Natural history
Superior articular process fracture
- potentially unstable
Inferior articular process fracture
- thought to be more stable
CT scan
Stability
- 24 patients with 26 unilateral facet joint fractures
- 5 patients developed instability requiring stabilization
- larger fragments at risk (> 40% of the lateral mass)
< 40% of the lateral mass
Superior articular facet fracture approximately 50% of the lateral mass
MRI
Totera et al Asian Spine J 2023
- 37 patients with unilateral facet joint dislocation
- failure of non operative treatment associated with traumatic disc injury
Management
Displaced
Stabilization
Undisplaced
Hard collar
Clinical and radiographic observation
- can develop anterolithesis
- incidence of spinal injury
Results
van Eck et al Asian Spine J 2017
- 74 patients with unilateral, minimal displaced facet joint fractures
- 15/74 (20%) progressed radiographically (> 10% listhesis)
- only two developed radiculopathy
- risks fractures for instability were initial fracture displacement or presentation with radiculopathy