ORIGINAL RESEARCH article
Front. Surg.
Sec. Orthopedic Surgery
This article is part of the Research TopicNavigating Uncertainty in Polytrauma and Associated Spine InjuriesView all articles
Optimizing Surgical Strategies for Subaxial Cervical Fracture-Dislocation: A Facet and Disc Injury-Based Approach
Provisionally accepted
- 1General Hospital of Ningxia Medical University, Yinchuan, China
- 2Ningxia Medical University, Yinchuan, China
- 3The First Affiliated Hospital of Dali University, Dali, China
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Objective: To investigate the influence of facet joint and intervertebral disc injuries on surgical approach selection in subaxial cervical fracture-dislocation. Methods: We retrospectively analyzed 150 patients with subaxial cervical fracture-dislocations, stratified by surgical approach: anterior (anterior-only or anterior-posterior) and posterior (posterior-only or posterior-anterior). Preoperative computed tomography (CT) and magnetic resonance imaging (MRI) were assessed to identify injury patterns, and radiographic and clinical outcomes were compared before and after surgery. Results: The mean patient age was 48.84 ± 11.68 years, and 86.7% completed at least 12 months of follow-up. The anterior group exhibited significantly higher rates of unilateral facet injuries (53.5% vs. 18.4%), perched/separated facets (59.4% vs. 34.7%), F2-type fractures (46.5% vs. 2%), and disc extrusion (40.9% vs. 15.4%). In contrast, the posterior group had more locked facets (55.1% vs. 15.8%) and non-fracture dislocations (79.6% vs. 23.8%). Bilateral injuries were commonly associated with locked or separated facets and absence of fracture. Patients undergoing combined posterior-anterior surgery had greater incidence of bilateral facet involvement and disc protrusion. Spinal alignment significantly improved postoperatively in all groups (P < 0.05), with no statistical difference in alignment correction between approaches. Twenty-four patients showed no neurological recovery, and 20 patients died during the follow-up period. Complication rates were higher in the posterior group (14.3%) compared to the anterior group (2.97%). Conclusion: Facet and disc injury patterns strongly affect surgical decision-making. Anterior approaches are preferable for disc extrusion or facet fractures, while posterior surgery is suited for locked facets without fractures. Accurate injury classification via imaging can guide individualized treatment and improve outcomes.
Keywords: Subaxial cervical, Fracture-dislocation, facet joint injury, disc injury, surgical approach
Received: 07 Oct 2025; Accepted: 11 Nov 2025.
Copyright: © 2025 Wang, Yao, Gong, Miao, Chu, Yang and Ge. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Kaishun Yang, yangkaishun@vip.sina.com
Zhaohui Ge, myovid@126.com
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