Surgical Management of Facet Fracture Dislocations of the Subaxial Spine: A Retrospective Cohort Study.

Introduction: Facet fracture dislocations of the subaxial spine pose notable risks of neurologic injury and spinal instability. The optimal surgical approach-whether anterior-alone, posterior-alone, or combined anterior-posterior-remains debated. The aim of this study was to evaluate the effectiveness, safety, and long-term outcomes of these surgical approaches.

Methods: A retrospective analysis of patients presenting with cervical facet fractures at a single level I trauma center was conducted. They were divided into anterior-alone, posterior-alone, and combined AP surgical groups. Primary outcomes including preoperative neurologic status (American Spinal Injury Association [ASIA] classification), intensive care unit stay, long-term neurologic recovery, and revision surgery rates were compared between patients undergoing each of these approaches.

Results: A total of 33 patients were included in the analysis. Bilateral dislocations were more common in the posterior group (87.5%) compared with the anterior group (50%). Anterior surgery was performed more frequently for C4-5 and C5-6 dislocations (57.1%). Patients with ASIA E were more likely to undergo anterior surgery while those with ASIA A-D tended to have combined or posterior approaches. The average intensive care unit stay was 8.9 days (median 3), 6.6 days (median 4), and 6.3 days (median 4) for anterior, posterior, and combined groups, respectively. Long-term neurologic recovery was observed in 28.6% of anterior patients, 12.5% of posterior patients, and 36.4% of combined patients. The anterior group had a higher revision surgery rate (14.3%; P = 0.284). Patients in the anterior group were most likely to be discharged home with minimal care requirements.

Conclusion: Anterior surgery is a particularly viable option for C4-5 and C5-6 dislocations in patients with minimal neurologic impairment. Combined AP surgery is more beneficial for bilateral C4-5 and C5-6 dislocations when severe neurologic deficits or other complex injuries necessitate greater stabilization. Posterior approaches may be preferable for complex bilateral dislocations, particularly at C6-7 and C7-T1, where anterior visualization is limited.