Treatment, Imaging Decisions Vary in Facet Dislocations

Spine surgeons showed little agreement in approach to examples of traumatic cervical injuries

TUESDAY, April 14 (HealthDay News) -- Spine surgeons may show a great deal of variability in how they respond to cervical facet dislocations, according to research published in the April Journal of Spinal Disorders & Techniques.

Jonathan N. Grauer, M.D., of the Yale University School of Medicine in New Haven, Conn., and colleagues presented 10 cases of traumatic bilateral or unilateral facet dislocations to 25 experienced spine surgeons. After reviewing vignettes, plain radiographs, and computed tomography scans, participants stated whether they would do a closed reduction, order an MRI, or proceed to open treatment. Then they were asked if they would do a closed or open reduction after viewing an MRI.

Reliability between the participants was very poor with regards to using closed reduction, obtaining an MRI, or moving directly to open treatment, the researchers report. After obtaining the MRI before attempting a reduction, the participants also showed poor interrater reliability about choosing an open versus closed procedure.

"The poor correlations in therapeutic decision making among this group of 'spine trauma experts,' and the fact that further diagnostic information did not substantially improve the agreement, would suggest that the lack of agreement is not necessarily related to inadequate clinical information. Rather, the lack of agreement may be because of varying interpretation of the imaging studies and varying appreciation and also evidence regarding the risks of the possible interventions," the authors write.

The study was supported by the Spine Trauma Study Group and Medtronic Sofamor Danek.

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