Variations in surgical treatment of cervical facet dislocations

Objective. To explore surgeon preference in the choice of surgical approach in the treatment of traumatic cervical facet dislocations. Summary of Background Data. The choice of surgical approach in the treatment of traumatic cervical dislocations is highly variable and maybe influenced by a variety of factors. The purpose of this study was to examine inter-rater reliability in choice of surgical approach. Methods. Twenty-five members of the Spine Trauma Study Group evaluated 10 cases of traumatic cervical dislocations. Evaluation of the case as a unilateral or bilateral injury and surgeon interpretation of the presence of a disc herniation as well as preferred surgical approach were assessed. Results. Only slight agreement was observed among surgeons in the choice of surgical approach (Kappa < 0.1). This improved slightly when patients were assumed to have a complete spinal cord injury (Kappa - 0.15). Surgeons used more anterior approaches either alone or as the first stage in a combined approach when a disc herniation was present regardless of neurologic status of the patient. When a patient was neurologically intact, an anterior approach was more common than a posterior approach even when a disc herniation was not present. Combined approaches were preferred for the treatment of bilateral facet dislocations. Conclusion. The poor agreement on the treatment of these injuries likely reflects a combination of factors including surgeon training and experience. Treatment decisions are likely to be affected by the neurologic status of the patient, interpretation of a disc herniation, and the classification of the injury as a unilateral or bilateral injury.