Vertical facet splitting: a special variant of rotary dislocations of the cervical spine

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✓ A special variant of rotary displacement of the cervical spine with vertical splitting of an inferior articular process by its articulating partner is reviewed. Eighteen patients with unilaterally locked facet joints confirmed by computerized tomography were seen between 1986 and 1991. Five patients presented with vertical split fractures of an inferior articular process by impaction of the superior process of the subjacent vertebra. This specific fracture pattern is not accounted for in current classifications. Four males and one female with a mean age of 31 years (range 16 to 49 years) were affected. Three of the patients showed no neurological deficits. One patient presented with cerebral contusion and paresis of the right upper extremity, and in one patient the posterior funiculus was involved. Three of the injuries had been sustained recently; the other two were of longer duration. Surgical treatment was chosen in the three cases of recent injury. In two cases surgery was prompted by neurological deficits; in the third case impaction was felt to be of inadequate depth. Surgery consisted in fracture reduction and interbody fusion using plates. The two cases of long-term fractures were treated conservatively, and ankylosis of the facet joints eventually provided adequate stability. If radicular or spinal symptoms are absent, this special variant of locked facet joints can successfully be treated conservatively leaving the rotary displacement uncorrected, provided impaction is adequately deep. The author's experience has shown that indications for surgical management are relative rather than absolute in this fracture variant and that use of computerized tomography is essential to establish the fracture pattern.

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Address reprint requests to: Ernst Sim, M.D., Kundratstraβe 37, A-1120 Wien, Austria.

© AANS, except where prohibited by US copyright law.

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    Case 4: Computerized tomography (CT) scans demonstrating splitting of the inferior articular process by its articulating partner 60 days after an injury at C6–7 occurred (A), and consolidation beginning at 95 days after the injury (B and C). The upper right facet of the subjacent vertebra, that is, the splitting one, is indicated by black arrows. Ankylosis (white arrows) of the right facet joint is shown at 15 months following injury on a horizontal CT scan (D) and in two parasagittal reconstructions (E). Three-dimensional reconstruction (F) shows the persistence of the rotatory displacement. X-ray films show anteroposterior and lateral views of the patient's condition at the time of referral (G). The white arrow indicates the facet joints C6–7. Additional x-ray films show right (H) and left (I) oblique views. On the right side the arrow marks the split facet; on the left the facets are shown in a perched position. Outcome of the patient's injury at 15 months is documented by anteroposterior and lateral x-ray films (J). Functional views were taken at the same time (K) showing the fused facet joint (black arrow); an additional black arrow at the ventral aspect of the cervical spine marks a console in C-7 following the injury.

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    Case 5: Computerized tomography (CT) scans demonstrating an injury at C6–7. A: A horizontal CT scan 29 days after the accident occurred shows the splitting facet (arrow). B: Callus formation (arrow) appears at 70 days. C: Outcome at 15 months can be seen in the fused facet joint (arrow).

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    Case 3: Computerized tomography (CT) scans demonstrating an injury at C3–4. Horizontal CT scans show a “locked” right facet joint (A and B). The scans show a concomitant fracture of the right lamina (white arrow, A) and the split facet (white arrow, B). Splitting can also be seen on three-dimensional reconstructions (C and D; x = posterior, y = anterior fragment of the split inferior facet on the right side, z = splitting superior facet of the subjacent vertebra). Black curved arrows mark the movements of the facets that lead to the splitting.

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