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Low failure rate seen with nonoperative treatment of cervical facet fractures

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ORLANDO, Fla.  — The low failure rate seen in a recent study when physicians nonoperatively treated unilateral facet fractures that were not dislocated and not perched supports using a hard collar or Halo immobilization for a trial period in neurologically intact patients, , according to a presenter at the Cervical Spine Research Society Annual Meeting, here.

Stephen F. Pehler, MD, of Birmingham, Ala., presented the findings of a retrospective review study that examined the failure rate of nonoperative treatment for non-dislocated, non-perched cervical facet fractures in 94 patients diagnosed with isolated, unilateral cervical facet fractures without dislocation.

“Non-dislocated, non-perched facet fractures could indeed warrant a trial of nonoperative treatment,” Pehler said.

Patients were treated with either a hard collar or Halo vest and outcomes were assessed based on radiographic healing and other factors. Pehler and colleagues determined the failure rate for nonoperative treatment was about 11%, which is a much lower failure rate than for the historical data, according to Pehler.

Investigators observed two trends in the patients who failed nonoperative treatment, which were a significantly higher fracture height and an intact lateral mass that was greater than 40% to 50% of the fracture height.

Among patients who failed nonoperative treatment, the average fracture height was 1.27 cm compared to an average fracture height of 0.92 cm among all patients studied, according to Pehler. The patients who failed nonoperative treatment also had a fracture height that was greater than 40% to 50% of the intact lateral mass compared to a fracture height that was 37% of the intact lateral mass in patients who did not fail nonoperative treatment. “Again when you look at the failures, it is fairly obvious that the ones with a higher fracture height and a higher involvement of the lateral mass were more predisposed to a failure,” Pehler said. – by Robert Linnehan

Reference:

Pehler SF. Paper #27. Presented at: Cervical Spine Research Society Annual Meeting; Dec. 4-6, 2014; Orlando, Fla.

Disclosure: Pehler has no relevant financial disclosures.