Unilateral facet dislocations: Is surgery really the preferred option?

Area of Science:

• Orthopedic surgery
• Neurosurgery
• Spinal cord injury

Background:

• Unilateral facet injuries are 6-10% of cervical spine injuries.
• Optimal treatment for these injuries is not established.
• Surgeons need evidence for operative vs. nonoperative management decisions.

Purpose of the Study:

• Compare safety and effectiveness of initial surgery versus nonoperative management for unilateral facet dislocations.
• Provide evidence to guide surgical decision-making for these injuries.

Main Methods:

• Systematic review of English literature (1970-2009).
• Included studies evaluated surgery vs. nonoperative management of unilateral facet dislocations.
• Excluded bilateral dislocations, isolated fractures, and complete spinal cord injuries.

Main Results:

• Nonoperative management had higher rates of treatment failure, neurological deterioration, and persistent pain.
• Surgical patients experienced infections and surgical complications.
• Surgery after failed nonoperative treatment yielded better outcomes.

Conclusions:

• Nonoperative treatment for unilateral facet dislocations is associated with more frequent treatment failure, persistent pain, and neurological deterioration.
• Surgical intervention may offer better outcomes based on current literature.
• Patient preference is a significant factor in choosing between operative and nonoperative management.