• Brian A Karamian, Gregory D Schroeder, Martin Holas, Andrei F Joaquim, Jose A Canseco, Shanmuganathan Rajasekaran, Lorin M Benneker, Frank Kandziora, Klaus J Schnake, F Cumhur Öner, Christopher K Kepler, Alexander R Vaccaro, and AO Spine Subaxial Injury Classification System Validation Group.
• Department of Orthopaedic Surgery, Rothman Institute at Thomas Jefferson University Hospital, 925 Chestnut St, 5th Floor, Philadelphia, PA, 19107, USA. brian.karamian@rothmanortho.com.
• Eur Spine J. 2021 Jun 1; 30 (6): 1635-1650.

PurposeTo determine the variation in the global treatment practices for subaxial unilateral cervical spine facet fractures based on surgeon experience, practice setting, and surgical subspecialty.MethodsA survey was sent to 272 members of the AO Spine Subaxial Injury Classification System Validation Group worldwide. Questions surveyed surgeon preferences with regard to diagnostic work-up and treatment of fracture types F1-F3, according to the AO Spine Subaxial Cervical Spine Injury Classification System, with various associated neurologic injuries.ResultsA total of 161 responses were received. Academic surgeons use the facet portion of the AO Spine classification system less frequently (61.6%) compared to hospital-employed and private practice surgeons (81.1% and 81.8%, respectively) (p = 0.029). The overall consensus was in favor of operative treatment for any facet fracture with radicular symptoms (N2) and for any fractures categorized as F2N2 and above. For F3N0 fractures, significantly less surgeons from Africa/Asia/Middle East (49%) and Europe (59.2%) chose operative treatment than from North/Latin/South America (74.1%) (p = 0.025). For F3N1 fractures, significantly less surgeons from Africa/Asia/Middle East (52%) and Europe (63.3%) recommended operative treatment than from North/Latin/South America (84.5%) (p = 0.001). More than 95% of surgeons included CT in their work-up of facet fractures, regardless of the type. No statistically significant differences were seen in the need for MRI to decide treatment.ConclusionConsiderable agreement exists between surgeon preferences with regard to unilateral facet fracture management with few exceptions. F2N2 fracture subtypes and subtypes with radiculopathy (N2) appear to be the threshold for operative treatment.© 2021. The Author(s).

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