Clinical and Radiographic Outcomes of Combined Posterior Transfacet Screw Fixation and Anterior Cervical Discectomy and Fusion Surgery for Unilateral Cervical Facet Fracture with Traumatic Disc Herniation: A Retrospective Cohort Study

INTRODUCTION: Combined lateral mass screw-rod (LMSR) fixation and anterior cervical discectomy and fusion (ACDF) surgery is currently the most widely described and accepted procedure for subaxial cervical facet fracture with traumatic disc herniation. Recent biomechanical studies have demonstrated that the use of transfacet screw (TFS) can be considered as a simple alternative method to LMSR. However, to date, little is known about the feasibility and effectiveness of TFS in the combined approach. The aim of this study was to compare the clinical and radiographic results of TFS + ACDF surgery and LMSR + ACDF surgery, and to provide a less invasive alternative technique for spine surgeons. METHOD: We retrospectively reviewed patients with unilateral cervical facet fracture with traumatic disc herniation who had undergone TFS + ACDF (N = 36) or LMSR + ACDF (N = 34) with a minimum 2-year follow-up. Clinical assessments, which included American Spinal Injury Association impairment scale (AIS), visual analog scale for neck pain (VASSNP) score and patient satisfaction, were made before surgery and at follow-up. For the radiographic outcomes, the instability parameters of segmental kyphosis and sagittal translation were measured. RESULTS: The demographic characteristics of the two groups of patients were similar. In terms of clinical outcomes, both two groups were associated with significant improvements at the final follow-up. There were no significant between-group differences in VASSNP score or patient satisfaction (both P > 0.05). The LMSR + ACDF group suffered more blood loss and had longer operative time (mean 206.0 ml; mean 274.4 min, respectively) than in the TFS + ACDF group (mean 110.0 ml; mean 142.8 min, respectively) (P < 0.001 for both comparisons). For the radiographic results, the segmental kyphosis and sagittal translation were significantly corrected after surgery in both groups (P < 0.001 for both groups), and no significant differences were found between groups at the last follow-up (P > 0.05). CONCLUSION: In the absence of any self-evident clinical and radiographic benefits of one technique over the other (TFS + ACDF vs. LMSR + ACDF), we recommend combined TFS + ACDF surgery as a safe and less invasive alternative treatment for unilateral cervical facet fractures with traumatic disc herniation, as it was associated with a shorter duration of surgery and lower estimated blood loss than LMSR + ACDF surgery.