PT  - JOURNAL ARTICLE
AU  - CHAPUT, CHRISTOPHER
AU  - HAILE, NATHAN B.
AU  - MUZUMDAR, ADITYA M.
AU  - GLOYSTEIN, DAVID M.
AU  - ZERRIS, VASILIOS A.
AU  - TORTOLANI, PAUL J.
AU  - RAHM, MARK
AU  - MOLDAVSKY, MARK
AU  - CHINTHAKUNTA, SURESH
AU  - KHALIL, SAIF
TI  - Anterior Fixation of Floating Facet Fractures in the Cervical Spine: A Prospective Case Series and Biomechanical Analysis
AID  - 10.14444/5014
DP  - 2018 Jan 01
TA  - International Journal of Spine Surgery
PG  - 85--91
VI  - 12
IP  - 1
4099  - https://www.ijssurgery.com/content/12/1/85.short
4100  - https://www.ijssurgery.com/content/12/1/85.full
SO  - Int J Spine Surg2018 Jan 01; 12
AB  - Background Unilateral fractures involving complete separation of the lateral mass from the vertebra and lamina (floating lateral mass fractures) are a unique subset of cervical spine fractures. These injuries are at significant risk for displacement without operative fixation. Posterior fixation has proven to facilitate adequate fusion. However, there are few data supporting the clinical success of single-level anterior fixation.Methods Biomechanical evaluation of floating lateral mass fractures and a consecutive case series of patients with rotationally unstable floating lateral mass fractures treated with anterior fixation using an integrated cage-screw device with anterior plating (ICSD) was performed. The study comprised 7 fresh human cadaver cervical spines (C2-C7), and 11 patients with floating lateral mass fractures. Segmental flexibility testing evaluating axial rotation, flexion/extension, and lateral bending was performed in a cadaveric model after 2 types of single-level anterior fixation and 1 type of 2-level posterior fixation. Eleven patients with a floating lateral mass fracture of the cervical spine underwent anterior fixation with an ICSD. Radiographs and clinical outcomes were retrospectively reviewed.Results Compared with the intact condition, posterior instrumentation significantly (P < .05) reduced range of motion (ROM) in all 3 planes; anterior fixation with cervical plate and interbody spacer significantly reduced ROM in lateral bending only; and the ICSD significantly reduced ROM in flexion/extension and lateral bending. In the clinical arm, there were no long-term complications, subsidence >2 mm, failure of fixation, reoperation, pseudoarthrosis, or listhesis at final follow-up.Conclusions The addition of 2 screws placed through a cervical cage can improve anterior fixation in a human cadaveric model of floating lateral mass fractures. Early clinical results demonstrate a low complication rate and a high rate of healing with single-level anterior fixation using this technique.