Predictive Factors for Failure of Closed Reduction in Traumatic Cervical Facet Dislocations: A Systematic Review of...

Study DesignSystematic review of clinical studies.ObjectiveTo identify neurological, anatomical, and technical predictors of failure in closed cranial traction (CCT) for traumatic cervical facet dislocations (CFD) in adults, and to synthesize evidence to guide early surgical decision-making.MethodsA systematic search was conducted across five databases: PubMed, PubMed Central (PMC), SciELO, Scopus, and Web of Science, for studies published from January 2000 to May 2025. Eligible studies included patients ≥16 years with traumatic CFD managed initially with CCT, reporting both success/failure rates and predictive variables. Data extraction focused on demographics, injury patterns, reduction techniques, and outcomes.ResultsEight studies met the inclusion criteria, encompassing 631 patients. Overall, the success rate of closed reduction was 73.3% (463/631), ranging from 56% to 92%. Consistently reported predictors of failure included complete neurological deficit (ASIA A-B; four studies), absence of a contralateral perched facet, involvement of the C7-T1 level, inferior endplate fracture, and attempts without general anesthesia. When open reduction was required after failed CCT, posterior approaches achieved higher success rates than anterior approaches (100% vs 45%).ConclusionsIn adults with traumatic cervical facet dislocations, CCT is more likely to fail with complete neurological deficits (ASIA A-B), C7-T1 involvement, absence of a contralateral perched facet, and awake traction protocols; GA-first strategies showed higher success in available cohorts. Unlike prior technique-focused overviews, this review consolidates predictors of CCT failure and proposes a practical algorithm to triage patients for early open reduction.