Facet Fractures: Which Have to Be Fixed?

The treatment of cervical facet fractures varies among injury subtypes. The recognition of those subtypes that can be associated with spinal segment instability and/or potential neurological deterioration can present a daunting clinical challenge. Appropriate clinical assessment and an evaluation of imaging studies including serial radiographs, multiplanar computed tomography, and magnetic resonance imaging are essential components of the decision-making process. In those patients treated with external immobilization, frequent follow-up with appropriate imaging studies is paramount to ensure maintenance of alignment and neurological status. Posterior lateral mass fixation and fusion provide superior biomechanical stabilization as compared with anterior stabilization alone when treating facet injuries; however, anterior stabilization may be considered to avoid the posterior approach and/or avoid additional levels of fusion.