Similar results from surgical, non-surgical treatment of cervical facet injuries

Surgically treated patients may experience improved recoveries and less pain with longer-term follow-up.

SEATTLE — Both surgical and nonoperative treatment of patients with unilateral cervical facet injuries yield similar pain and disability outcomes, a study suggests. However, surgically treated patients may experience better recoveries over the long-term, the authors said.

Marcel Dvorak, MD, FRCS(C), an associate professor of orthopedics at the University of British Columbia, Vancouver, and colleagues at six centers in Canada and the United States retrospectively compared outcomes for 66 patients treated for unilateral cervical facet injuries with at least 1 year of follow-up. Patients' injuries ranged from C3 to T1; 53 were treated surgically and 13 were managed nonoperatively, according to the study.

Dvorak presented the results here at the North American Spine Society (NASS) 21st Annual Meeting.

In their primary data analysis, the researchers found no significant difference between treatment groups. However, a subgroup analysis suggests that surgically treated patients may experience less pain over longer-term follow-up.

Overall, NASS Pain/Disability scores averaged 85.58, with perfect scores reported by 30% of patients. SF-36 Bodily Pain scores averaged 68.3, which was "significantly lower than the mean of a normative sample of the healthy population," the study authors said.

Compared to nonoperative patients, patients treated surgically had an average NASS pain scale score 3.8 points higher and an average SF-36 Bodily Pain score 10.6 points higher.

However, "A subgroup analysis suggested that in the short term (less than 18 months), [surgically treated] and [nonoperative] patients report similar pain, [but] with longer follow-up, the [surgically] treated patients experience improved recovery while the [nonoperative] patients report higher levels of pain," the authors said in the abstract.

Among patients followed for more than 18 months, the NASS Pain/Disability score averaged 12.7 points higher for those treated surgically compared to those managed nonoperatively (P=.05), according to the study.

"This hypothesis-generating finding may be due to the development of secondary degenerative changes in the [nonoperative] patients over time, and further analysis with larger samples is required," they said.

Medtronic Sofamor Danek provided the researchers — the Spine Trauma Study Group — with grant and research support.

For more information:
Dvorak M, Aarabi B, Rampersaud R, et al. Outcomes of operative versus nonoperative treatment of unilateral cervical facet fracture subluxations. #80. Presented at the North American Spine Society 21st Annual Meeting. Sept. 26-30, 2006. Seattle.