Characteristics of Unilateral Cervical Spine Facet Fractures: A Case Series of Adult Trauma Patients

Danielle E Chipman; Thomas J Ryan; David Kowalski; Christopher Lucasti; Maxwell M Scott; Emily K Vallee; Alexander Yunke; Dil V Patel; Justin Bird; Lindsey D Clark; Joseph M Kowalski

doi:10.1097/BSD.0000000000001865

Characteristics of Unilateral Cervical Spine Facet Fractures: A Case Series of Adult Trauma Patients

Clin Spine Surg. 2025 Jun 16. doi: 10.1097/BSD.0000000000001865. Online ahead of print.

Affiliations

¹ Jacobs School of Medicine and Biomedical Sciences.
² Department of Orthopaedics, University at Buffalo, Buffalo, NY.

PMID: 40521735
DOI: 10.1097/BSD.0000000000001865

Abstract

Study design: Clinical case series.

Objective: The objective of this case series is to describe the demographics, mechanisms of injury, radiologic imaging measurements, and treatment of unilateral cervical facet fractures in adult trauma patients.

Summary of background data: Unilateral cervical facet fractures are rare and traumatic injuries of the spine that are frequently misdiagnosed and misclassified. There is a lack of consensus on the appropriate management for various severities of unilateral facet fractures.

Methods: All patients over 18 years old who presented at a single center between September 2015 and March 2023 with a unilateral cervical facet fracture were identified. Fracture height and percentage of the lateral mass were measured on computerized tomography (CT). Demographics, treatment course, and intrahospital data were collected.

Results: Of the 554 patients identified, 22 met final inclusion and exclusion criteria. The median age was 37.5 (IQR: 36) years, and 68% were male. The most common mechanisms of injury were a motor vehicle crash (55%) or a fall (23%). Seven (32%) patients required surgical intervention, and 15 (68%) patients were treated nonoperatively. The average fracture height for all participants was 1.11 ± 0.4 cm, and the average percentage of the lateral mass was 42.3% ± 18.0%. After 1 year of follow-up, all patients treated nonoperatively had successful outcomes, with no treatment failures or need for surgical intervention.

Conclusion: Patients who sustained a unilateral cervical spine facet fracture from a traumatic injury mechanism with fracture fragments >1 cm or >40% of the lateral mass on CT scan can effectively be treated nonoperatively. No patient treated nonoperatively failed treatment and required surgery at 1 year. We recommend considering operative intervention in patients with high-energy mechanisms of injury coupled with the abovementioned radiographic parameters.

Keywords: cervical spine; trauma; unilateral facet fracture.