Management of post-traumatic bilateral jumped facets: a systematic review

Background: Bilateral jumped facets (BJF) are serious cervical spine injuries that require reduction and surgical stabilization. Closed reduction often performed, however, the argument of having disc herniation suggested deferred treatment until MRI is done. The later has been criticised for delaying the treatment. Methodology: We conducted a systematic review focusing on BJF in order to assess the validity of performing an MRI prior to closed reduction. The immediate neurological state after reduction and long term outcome were the primary goals. Results: A total of 49 articles were found (1973-2014). Only 20 of them fit our criteria. A total of 203 BJF were evaluated with C6/7 and C5/6 being the most common level of injury. Closed reduction was performed in 194 patients with no MRI in 118 patients. Clinical changes had occurred in 7 patients (3 improved, 2 worsened, 2 transient worsening). The long term outcome showed no significant difference between the two groups who had closed reduction before or after the MRI (p>0.05) Conclusion: The risk of neurological worsening with closed reduction prior to MRI is low and insignificant. The MRI will be helpful post reduction to assess the status of the cord and adequacy of closed reduction, especially in comatose patients.