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Cervical spine injuries associated with lateral mass and facet joint fractures: new classification and surgical treatment with pedicle screw fixation

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Title: Cervical spine injuries associated with lateral mass and facet joint fractures: new classification and surgical treatment with pedicle screw fixation
Authors: Kotani, Yoshihisa Browse this author →KAKEN DB
Abumi, Kuniyoshi Browse this author
Ito, Manabu Browse this author
Minami, Akio Browse this author →KAKEN DB
Keywords: Cervical lateral mass fracture
Facet joint fracture
Discoligamentous injury
Magnetic resonance imaging
Cervical pedicle screw
Issue Date: Feb-2005
Publisher: Springer Berlin / Heidelberg
Journal Title: European Spine Journal
Volume: 14
Issue: 1
Start Page: 69
End Page: 77
Publisher DOI: 10.1007/s00586-004-0793-2
PMID: 15723250
Abstract: To clarify the injury pattern, initial spinal instability, degree of discoligamentous injuries in cervical lateral mass and facet joint fractures, we retrospectively analyzed radiological parameters and introduced a new classification for these injuries. Surgical treatment was performed with cervical pedicle screw fixation (CPS), and overall neurological and radiological outcome was evaluated with a minimum follow-up period of 2 years. Lateral mass fractures were divided into the following four subtypes: separation, comminution, split, and traumatic spondylolysis. The sagittal and frontal alignments were evaluated at both mainly injured and adjacent spinal segments on radiographs. The initial discoligamentous injuries were investigated on magnetic resonance imaging in terms of their frequencies, subtype of injuries, and involved spinal levels. Anterior translation of fractured vertebra was demonstrated in 77% of lateral mass fractures, while 24% of anterior translation was observed, even in cephalad-adjacent vertebrae. On magnetic resonance imaging, signal changes in anterior longitudinal ligament (ALL) and intervertebral disc were demonstrated in 76% of caudal segments and 24% of cephalad segments adjacent to fractured vertebra of lateral mass fractures. The subtype analyses of lateral mass fractures demonstrated high rates of anterior translation in separation, split, and traumatic spondylolisthesis, as well as significant coronal malalignment in comminution and split types (p<0.05). Thirty-one patients underwent surgical treatments using a cervical pedicle screw fixation. The CPS provided the superior capability of deformity correction without pseudoarthrosis, as well as excellent neurological recovery. The average numbers of stabilized segments were minimized without serious complications. In separation, facet joint fracture, and fractures with mild lateral mass comminution, the single level posterior fixation can be considered. The significant unstable injuries of split and comminution type with coronal malalignment can be treated with exclusive two-level posterior stabilization with CPS. The initial evaluation of fracture subtypes helps to successfully minimize the stabilized spinal segment
Rights: The original publication is available at
Type: article (author version)
Appears in Collections:医学院・医学研究院 (Graduate School of Medicine / Faculty of Medicine) > 雑誌発表論文等 (Peer-reviewed Journal Articles, etc)

Submitter: 小谷 善久

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