Articular process fractures

Articular process fracture

 

Natural history

 

Superior articular process fracture

- potentially unstable

 

Inferior articular process fracture

- thought to be more stable

 

CT scan

 

Cervical Spine Facet FractureCervical Superior Articular Facet Fracture0001Cervical Superior Articular Facet Fracture0002

 

Stability

 

Spector et al Spine 2006

- 24 patients with 26 unilateral facet joint fractures

- 5 patients developed instability requiring stabilization

- larger fragments at risk (> 40% of the lateral mass)

 

Small superior articular facet fracture

< 40% of the lateral mass

 

Large superior articular facet fractureSup art 1Sup art 2

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