Traumatic subaxial cervical facet subluxation and dislocation: epidemiology, radiographic analyses, and risk factors for spinal cord injury

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dc.contributor.authorQuarrington, R.
dc.contributor.authorJones, C.
dc.contributor.authorTcherveniakov, P.
dc.contributor.authorClark, J.
dc.contributor.authorSandler, S.
dc.contributor.authorLee, Y.
dc.contributor.authorTorabiardakani, S.
dc.contributor.authorCosti, J.
dc.contributor.authorFreeman, B.
dc.date.issued2018
dc.description.abstractBackground Context: Distractive flexion injuries (DFIs) of the subaxial cervical spine are major contributors to spinal cord injury (SCI). Prompt assessment and early intervention of DFIs associated with SCI are crucial to optimize patient outcome; however, neurologic examination of patients with subaxial cervical injury is often difficult, as patients commonly present with reduced levels of consciousness. Therefore, it is important to establish potential associations between injury epidemiology and radiographic features, and neurologic involvement. Purpose: The aims of this study were to describe the epidemiology and radiographic features of DFIs presenting to a major Australian tertiary hospital and to identify those factors predictive of SCI. The agreement and repeatability of radiographic measures of DFI severity were also investigated. Study Design/Setting: This is a combined retrospective case-control and reliability-agreement study. Patient Sample: Two hundred twenty-six patients (median age 40 years [interquartile range = 34]; 72.1% male) who presented with a DFI of the subaxial cervical spine between 2003 and 2013 were reviewed. Outcome Measures: The epidemiology and radiographic features of DFI, and risk factors for SCI were identified. Inter- and intraobserver agreement of radiographic measurements was evaluated. Methods: Medical records, radiographs, and computed tomography and magnetic resonance imaging scans were examined, and the presence of SCI was evaluated. Radiographic images were analyzed by two consultant spinal surgeons, and the degree of vertebral translation, facet apposition, spinal canal occlusion, and spinal cord compression were documented. Multivariable logistic regression models identified epidemiology and radiographic features predictive of SCI. Intraclass correlation coefficients (ICCs) examined inter- and intraobserver agreement of radiographic measurements. Results: The majority of patients (56.2%) sustained a unilateral (51.2%) or a bilateral facet (48.8%) dislocation. The C6–C7 vertebral level was most commonly involved (38.5%). Younger adults were over-represented among motor-vehicle accidents, whereas falls contributed to a majority of DFIs sustained by older adults. Greater vertebral translation, together with lower facet apposition, distinguished facet dislocation from subluxation. Dislocation, bilateral facet injury, reduced Glasgow Coma Scale, spinal canal occlusion, and spinal cord compression were predictive of neurologic deficit. Radiographic measurements demonstrated at least a “moderate” agreement (ICC>0.4), with most demonstrating an “almost perfect” reproducibility. Conclusions: This large-scale cohort investigation of DFIs in the cervical spine describes radiographic features that distinguish facet dislocation from subluxation, and associates highly reproducible anatomical and clinical indices to the occurrence of concomitant SCI.
dc.description.statementofresponsibilityRyan D. Quarrington, Claire F. Jones, Petar Tcherveniakov, Jillian M. Clark, Simon J.I. Sandler, Yu Chao Lee, Shabnam Torabiardakani, John J. Costi, Brian J.C. Freeman
dc.identifier.citationThe Spine Journal, 2018; 18(3):387-398
dc.identifier.doi10.1016/j.spinee.2017.07.175
dc.identifier.issn1529-9430
dc.identifier.issn1878-1632
dc.identifier.orcidQuarrington, R. [0000-0002-0633-2482]
dc.identifier.orcidJones, C. [0000-0002-0995-1182]
dc.identifier.orcidSandler, S. [0000-0002-1887-8677]
dc.identifier.orcidTorabiardakani, S. [0000-0002-8802-8563]
dc.identifier.orcidFreeman, B. [0000-0003-0237-9707]
dc.identifier.urihttps://hdl.handle.net/2440/132358
dc.language.isoen
dc.publisherElsevier
dc.relation.granthttp://purl.org/au-research/grants/nhmrc/1072387
dc.rights© 2017 Elsevier Inc. All rights reserved.
dc.source.urihttps://doi.org/10.1016/j.spinee.2017.07.175
dc.subjectCervical facet dislocation; distractive flexion injury; epidemiology; radiographic analysis; risk factor; spinal cord injury
dc.subject.meshCervical Vertebrae
dc.subject.meshHumans
dc.subject.meshSpinal Cord Injuries
dc.subject.meshSpinal Fractures
dc.subject.meshTomography, X-Ray Computed
dc.subject.meshMagnetic Resonance Imaging
dc.subject.meshRadiography
dc.subject.meshAdult
dc.subject.meshAged
dc.subject.meshMiddle Aged
dc.subject.meshFemale
dc.subject.meshMale
dc.subject.meshJoint Dislocations
dc.titleTraumatic subaxial cervical facet subluxation and dislocation: epidemiology, radiographic analyses, and risk factors for spinal cord injury
dc.typeJournal article
pubs.publication-statusPublished

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