Treatment Strategy for Subaxial Minimal Facet/Lateral Mass Fractures: A Comprehensive Clinical Review

Area of Science:

• Orthopedics
• Neurosurgery
• Radiology

Background:

• Subaxial cervical spine (C3-C7) fractures, particularly minimal facet and lateral mass types, pose diagnostic and therapeutic challenges.
• These injuries often result from low-energy trauma and can be deceptively stable, risking delayed instability or neurological compromise.
• Associated vertebral artery injuries (VAI) add complexity to management, necessitating stroke risk mitigation.

Purpose of the Study:

• To provide a comprehensive review of minimal facet and lateral mass fractures in the subaxial cervical spine.
• To analyze diagnostic modalities, treatment strategies, and management of associated vertebral artery injuries.
• To highlight advancements in imaging, surgical techniques, and interventional radiology for improved patient outcomes.

Main Methods:

• Review of current literature on subaxial cervical spine fractures.
• Analysis of diagnostic accuracy using plain radiography, CT, and MRI.
• Evaluation of treatment algorithms based on fracture stability, neurological status, and VAI presence.

Main Results:

• Accurate diagnosis requires multimodal imaging (CT, MRI) to assess bony and soft tissue integrity.
• Treatment is guided by stability, with conservative management for stable fractures and surgical stabilization for instability.
• Management of VAI necessitates a multidisciplinary approach involving neurosurgery, vascular surgery, and interventional radiology.

Conclusions:

• Optimal management of subaxial cervical spine fractures requires a tailored approach considering fracture patterns and patient factors.
• Advances in diagnostics and therapeutics are improving outcomes, but high-quality evidence remains limited.
• Further understanding of natural history and optimal strategies is crucial for refining clinical decision-making.