From the Guidelines
The treatment for a nondisplaced fracture of the superior facet of the sixth cervical (C6) vertebra typically involves simple immobilization, as surgery is usually reserved for more complex cases with significant displacement or articular involvement 1. When managing a nondisplaced C6 superior facet fracture, the primary goal is to ensure proper healing and alignment while minimizing the risk of complications.
- Key considerations include:
- Immobilization: The use of a rigid cervical collar for a period of 6-12 weeks is often recommended to provide stability and support to the affected area.
- Pain management: Acetaminophen and NSAIDs, such as ibuprofen, can be used to manage mild to moderate pain, while muscle relaxants like cyclobenzaprine or methocarbamol may be prescribed for more severe pain.
- Follow-up care: Regular follow-up appointments with imaging studies at 2-4 week intervals are crucial to monitor the healing process and detect any potential complications early.
- Physical therapy: Gentle range of motion exercises and gradual strengthening can be introduced after the initial immobilization period to promote recovery and prevent stiffness.
- It is essential to note that surgery is rarely necessary for nondisplaced facet fractures, unless there are signs of neurological compromise, instability, or displacement during treatment 1.
- Patients should be advised to avoid high-impact activities and contact sports until complete healing is confirmed, usually after 3-4 months, to minimize the risk of further injury or complications.
From the Research
Treatment Options for Nondisplaced Fracture of the Superior Facet of the Sixth Cervical (C6) Vertebra
- The treatment for a nondisplaced fracture of the superior facet of the sixth cervical (C6) vertebra can vary depending on several factors, including the patient's overall health, the severity of the injury, and the presence of any associated injuries 2, 3.
- Nonoperative management with external immobilization using a hard cervical collar may be sufficient for some patients with nondisplaced cervical facet fractures, with a success rate of over 80% in some studies 4.
- However, some patients may require surgical intervention, particularly if they have associated injuries or if nonoperative management fails 2, 5.
- The decision to operate or not should be based on a thorough evaluation of the patient's condition, including imaging studies and clinical assessment 3, 6.
Factors Influencing Treatment Outcome
- The type of facet fracture, including the location and orientation of the fracture, may not be a significant factor in determining the outcome of treatment 4.
- The presence of associated injuries, such as ligamentous disruption or other fractures, may increase the risk of instability and require surgical intervention 2, 4.
- The patient's age and overall health may also influence the treatment outcome, with younger patients potentially being at higher risk of instability 2.
Surgical Management
- Surgical management may involve open reduction and instrumented posterior fixation, particularly in cases where nonoperative management has failed or if there is significant instability 5.
- The goal of surgical management is to restore stability to the cervical spine and prevent further injury or complications 2, 6.