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Floating Lateral Mass Fractures of the Cervical Spine
Mark W Manoso1, Timothy A Moore2, Julie Agel3
1Uniformed Services University of the Health Sciences, Department of Surgery, MD.
Spine
|March 2, 2016
Summary
Floating lateral mass (FLM) fractures are high-energy injuries often involving two motion segments, frequently causing vertebral artery injuries and neurological deficits. Two-level Anterior Cervical Discectomy and Fusion (ACDF) or Posterior Spinal Instrumented Fusion are effective treatments.
Area of Science:
- Orthopedic surgery
- Neurosurgery
- Trauma surgery
Background:
- Floating lateral mass (FLM) fractures, a subset of unilateral lateral mass fractures involving the adjacent pedicle and lamina, are uncommon and poorly described.
- These injuries result from high-energy trauma, often high-speed motor vehicle accidents.
Purpose of the Study:
- To characterize FLM fractures, including injury mechanisms, anatomical patterns, associated vascular and neurological injuries, and radiographic features.
- To determine the most effective treatment methods for FLM fractures.
Main Methods:
- A Level I trauma center case series was conducted.
- Sixty consecutive FLM fractures (C3-C7) were identified from prospectively collected trauma registries between 2007 and 2012.
- Patient data, including injury mechanisms, imaging, neurological status, and treatment outcomes, were analyzed.
Main Results:
- The most common level affected was C6, with high-speed motor vehicle accidents being the primary mechanism (45%).
- Radiographic findings included anterolisthesis and facet joint widening (63%).
- Associated injuries comprised vertebral artery injuries (22%) and neurological deficits such as radiculopathy (38%) and spinal cord injury (18%). Nonoperative treatment led to subluxation in all patients, necessitating surgery in six.
- Operative treatment included two-level Anterior Cervical Discectomy and Fusion (ACDF) in 53% of patients, with posterior fusion or combined approaches used in others. One-level ACDF showed a high failure rate (83%).
Conclusions:
- FLM fractures are high-energy injuries affecting two motion segments, frequently associated with vertebral artery injuries and neurological deficits.
- Magnetic Resonance imaging revealed significant disc injury in 81% of patients, typically at the lower motion segment.
- Two-level ACDF or Posterior Spinal Instrumented Fusion are effective treatment options for FLM fractures.
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