Wednesday, October 30, 2001 4:42–5:25 pm Concurrent Session 2A: Cervical Spine Surgery Complications

Purpose of study: Significant controversy persists regarding the ideal treatment of an isolated unilateral jumped or locked facet after cervical spine trauma. The purpose of this study was to examine the efficacy and outcomes of such a purely anterior technique for the treatment of a unilateral jumped facet. Methods used: Between 1994 and 2002, a retrospective review was conducted at the Los Angeles County General Hospital to identify a total of 56 patients with cervical spine trauma and unilateral jumped facet syndrome who were subsequently treated by anterior cervical discectomy and fusion. Demographic data, initial neurological examinations, surgical data, radiographic findings and follow-up records were reviewed. The mean follow-up was 14.5 months with greater than 6-month follow-up available in 95% of patients. Treatment failure was identified as progression of cervical deformity, graft or hardware migration, or new neurological deficit. Time to failure was divided arbitrarily into immediate (0 to 4 weeks), early (4 weeks to 3 months), middle (3 to 6 months) and late (longer than 6 months). of findings: We identified a total of 13 treatment failures (23%) documented on delayed radiographic imaging. Within the failure group, the following variables were identified as carrying a negative prognosis as compared with the overall cohort: high-speed mechanisms of trauma (eg, motor vehicle accident vs. simple assault), presence of a motor deficit or numbness, reflex changes, loss of consciousness and/or intracranial bleed, smoking, other systemic diseases, lesions of the cervicothoracic junction (C6–T1), evidence of increased T2-signal or disc changes on the initial magnetic resonance imaging scan, presence of kyphosis or disc height loss at the injured level and successful preoperative halo reduction at a low weight. Of these, high-speed mechanisms, neurological deficit, intracranial bleeding and the presence of kyphosis were statistically significant (p Relationship between findings and existing knowledge: Our observation of a 23% failure rate at a mean interval of 11.2 weeks after anterior reconstruction for unilateral jumped facet syndrome is slightly higher than that previously reported in the literature. This study represents one of the largest single-institution studies from a major trauma center and may reflect a higher proportion of high-impact type injuries. The other negative prognostic variables suggest that a more serious injury was likely initially present in the patients whose anterior construct failed. Overall significance of findings: Careful analysis of the exact injury is needed for cases of cervical unilateral jumped facets. Whereas anterior discectomy and plating may prove adequate for low-impact type injuries, it may be inadequate for more serious cases with higher force injuries. Identification of features suggestive of more serious injury, including the ones listed above, may help guide treating surgeons to identify which patients require circumferential stabilization. Disclosures: No disclosures. Conflict of interest: No conflicts.