Outcome of 51 cases of unilateral locked cervical facets: interspinous braided cable for lateral mass plate fusion compared with interspinous wire and facet wiring with iliac crest

Object. To increase knowledge about unilateral facet dislocation, including presentation, radiological findings, management, and outcome, the authors reviewed the cases of 51 consecutive patients with unilateral locked facets of the cervical spine who underwent treatment over an 11-year period. With the development of internal fixation devices, the authors compared the pro cedure of using interspinous wire and facet wiring of iliac crest to fix un ilateral locked facets with that in which interspinous braided cable and la teral mass plates were used. Methods. Thirty-seven patients (73%) presented with radiculopathy, eight (1 6%) with neck pain only, and six (12%) with spinal cord injuries (SCIs). Pl ain x-ray films demonstrated subluxation in only 44 (86%) of 51 cases. All patients underwent cervical computerized tomography (CT) scanning, and in a ll patients with SCI, a magnetic resonance (MR) image was obtained. Fractur e in addition to facet locking was seen on 24 (47%) of 51 CT scans. Disc di sruption with cord compression was seen in five cases (10%). Based on CT an d/or MR imaging findings, a closed reduction procedure was believed to be c ontraindicated in 11 cases (22%). Of the remaining 40 patients, 13 (33%) un derwent closed reduction procedures. Two patients who underwent a closed re duction procedure were placed in a halo brace but experienced resubluxation . Thus, all cases were surgically treated. Forty-six patients underwent pos terior reduction and/or internal fixation alone (in 24 cases spinous proces s fixation with facet wiring was connected to struts of iliac crest, and in 22 cases interspinous braided cable far lateral mass plating was used). In itial surgery, regardless of technique, was successful in 45 (98%) of 46 ca ses. One patient experienced a resubluxation and underwent reoperation in w hich anterior cervical fusion and plating were performed. Four of six patie nts with SCI underwent an emergency combined anterior-posterior decompressi ve procedure in which internal fixation was performed, and the patients exp erienced immediate neurological improvement. Overall there were no cases of neurological worsening or death, and there were three cases of wound infec tion. At 1 year postsurgery, all deficits had improved. Of 37 cases of radi culopathy, three patients (8%) experienced persistent 4/5 weakness, and the remaining patients were normal, including four patients in whom diagnosis was delayed. The six patients with SCI all improved significantly by 1 year . Persistent neck pain was seen in nine cases (18%). Although the lateral m ass plates and interspinous cable are stronger, easier to place, and signif icantly lessened the amount of resultant kyphosis (p < 0.02), the results o f chi-square analysis demonstrated only a slight trend for improved clinica l outcome compared with the use of wire and iliac crest (p = 0.1). Conclusions. Cervical CT and MR imaging provide information that aids in th e diagnosis and management of patients with unilateral locked facets of the cervical spine. The authors' experience strongly suggests that a reduction procedure in which internal fixation and bone fusion are performed will be the most successful treatment for this injury.