6th World Congress on
Spine and Spinal Disorders

Background: Bilateral jumped facets (BJF) are serious cervical spine injuries that require reduction and surgical stabilization. Closed reduction is often performed, however, the argument of having an associated disc herniation has suggested deferred surgical treatment until MRI is done. Such an approach has been criticised for delaying cord decompression and lower the chance of recovery.

Purpose: Evaluate the impact of MRI in determining the outcome of bilateral jumped facets who requires an immediate closed reduction 

Study design: Systematic review

Patient sample: Acute posttraumatic cervical bilateral jumped facets

Outcome measures: Frankel grade at long-term follow-up

Methodology: We conducted a systematic review focusing on BJF to assess the validity of performing an MRI before closed reduction. Due to the paucity of reports, we included all retrospective and case series that described the management of each individual. In order to monitor the neurological function, we unified the neurological grades to follow Frankel grading system. The neurological state was monitored from the time of admission, post closed reduction and after surgical stabilization. The immediate neurological state after closed reduction and long term neurological outcome were the primary goals of the study, which were compared between two groups based on the event of obtaining MRI before closed reduction.

Results: A total of 56 articles were found (1973-2019) through English literature. Twenty articles were included based on inclusion criteria. A total of 203 BJF were evaluated with C6/7 and C5/6 being the most common levels of injury. Closed reduction was performed in 194 patient with no MRI scanning in 118 patients. Clinical changes in post-reduction had occurred in 7 patients (3 improved, 2 worsened, 2 transient worsenings). The long term outcome showed no significant difference in neurological function between the two groups who had closed reduction before or after the MRI (p>0.05).

Conclusion: Cervical MRI may be useful in post-traumatic BJF, however, the closed reduction should not be delayed by obtaining pre-reduction MRI. The risk of neurological worsening is low and insignificant in patients who underwent closed reduction without a pre-reduction MRI. The MRI will be helpful in immediate post reduction to assess the status of the spinal cord and the adequacy of closed reduction, especially in comatose patients.