• Fabio Cofano, Giuseppe Junior Sciarrone, Michele Federico Pecoraro, Nicola Marengo, Marco Ajello, Federica Penner, Salvatore Petrone, Alessandro Ducati, Francesco Zenga, Corrado Musso, and Diego Garbossa.
• Division of Neurosurgery, Department of Neuroscience, University of Turin, Turin, Italy. Electronic address: fabio.cofano@gmail.com.
• World Neurosurg. 2019 Jun 1; 126: 447-452.

BackgroundAmong the posterior techniques, the use of cervical interfacet spacers (CISs) represents a promising technology whose potentialities are still being studied. The purpose of the present review was to assess the available data on CISs.MethodsA search on PubMed was performed. The search terms were "cervical interfacet spacers," "facet spacers," "DTRAX facet system," "Goel facet spacer," "pseudarthrosis," "cervical lordosis," "iatrogenic kyphosis," "cervical foraminal decompression," "cervical biomechanics," "atlantoaxial instability," and "subaxial instability."ResultsMechanical studies have shown that stand-alone CISs promoted stiffness in all directions, except for extension. Foraminal distraction was recorded in 86% of the cases. Clinical studies have shown that the use of CISs could promote successful arthrodesis, given the large surface area affected by fusion and decreasing the need for autografts. The effectiveness for the treatment of radiculopathy has been confirmed by several clinical studies. In a series of 154 levels of implanted CISs, no evidence of significant loss of cervical lordosis was identified. CISs could help in enhancing fusion in C1-C2 fixation.ConclusionsBiomechanical studies on specimens showed a positive trend in increasing stiffness of the cervical spine, despite some controversial results. In clinical studies, facet distraction was shown to be a safe and valid option for clinical indirect decompression, although longer follow-up is required for confirmation. No evidence of the loss of cervical lordosis has been recorded. The long-term effects and CIS use in revision procedures as adjuvant implants to treat pseudarthrosis or atlantoaxial instability are currently under investigation, and further studies are needed.Copyright © 2019 Elsevier Inc. All rights reserved.

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