{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T05:17:14Z","timestamp":1777958234096,"version":"3.51.4"},"reference-count":62,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,8,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>Closed skeletal traction (CST) to reduce unilateral locked facets in the subaxial cervical spine can expedite spinal realignment prior to definitive surgery but is not always successful. What predicts successful closed reduction is not completely understood. In addition, whether open anterior or posterior surgery is superior for achieving successful reduction after failed closed skeletal traction has not been investigated. The authors sought to assess predictors of successful closed reduction with skeletal traction and to compare the efficacy of anterior versus posterior surgery after failed closed reduction.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>The authors performed a retrospective analysis of patients presenting to a single level I trauma center with a de facto unilateral locked facet between 2008 and 2024. Patients with a complex facet fracture without a locked facet, bilateral locked facet, and\/or no attempted CST were excluded. Fractures involving discrete, structurally relevant bony elements and other pathological features, and variables of reduction technique were recorded. Successful reduction was determined by restoration of anatomical alignment on fluoroscopy prior to surgery and verified with postoperative CT.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Fifty-five patients met the inclusion criteria. The population was 71% male, and the mean age was 47 \u00b1 18 years. Closed reduction was successful in 56% of patients. The mean maximum weight applied was 60 \u00b1 33 lb. Awake CST had a 48% success rate and CST under general anesthesia (GA) had an overall success rate of 61%. Upfront CST under GA (without prior unsuccessful awake CST) had a success rate of 83%, but no cases of failed awake CST were successfully reduced with subsequent CST under GA. On multivariate analysis, a contralateral perched facet increased the odds of successful closed reduction by 32-fold and presence of neurological injury (AIS grades A\u2013D) reduced the odds of successful closed reduction by 21-fold. In patients requiring open surgical reduction after failed CST, posterior surgery was significantly more successful than anterior surgery (100% vs 45%, p = 0.026). Of the 6 patients in whom open reduction failed via an anterior approach, 5 underwent successful reduction during subsequent posterior surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>A contralateral perched facet predicted successful CST, whereas any neurological deficit (AIS grade A\u2013D) predicted failed CST. GA increased the odds of successful closed reduction but did not salvage failed awake CST attempts. In patients in whom CST failed and open surgical reduction was required, posterior surgery was significantly more successful than anterior surgery for reestablishing anatomical alignment.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2025.3.spine241107","type":"journal-article","created":{"date-parts":[[2025,5,23]],"date-time":"2025-05-23T22:30:14Z","timestamp":1748039414000},"page":"143-153","source":"Crossref","is-referenced-by-count":2,"title":["Reduction of traumatic unilateral locked facet of the subaxial cervical spine: what predicts successful closed skeletal traction, and is anterior or posterior surgery superior after unsuccessful closed reduction?"],"prefix":"10.3171","volume":"43","author":[{"given":"Bradley","family":"Wilhelmy","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, Maryland;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Riccardo","family":"Serra","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, Maryland;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Parantap","family":"Patel","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, Maryland;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jesse","family":"Stokum","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, Maryland;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ovais","family":"Hasan","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, Maryland;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rong","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland;"},{"name":"Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chixiang","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, Maryland;"},{"name":"Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kristopher","family":"Hooten","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, Maryland;"},{"name":"Department of Neurosurgery, Walter Reed Medical Center, Bethesda, Maryland; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ross","family":"Puffer","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, Maryland;"},{"name":"Department of Neurosurgery, Walter Reed Medical Center, Bethesda, Maryland; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Steven","family":"Ludwig","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, University of Maryland School of Medicine, Baltimore, Maryland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kenneth","family":"Crandall","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, Maryland;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gary","family":"Schwartzbauer","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, Maryland;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Charles","family":"Sansur","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, Maryland;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bizhan","family":"Aarabi","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, Maryland;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Timothy","family":"Chryssikos","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, Maryland;"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"17","key":"b1","series-title":"Spine (Phila Pa 1976)","first-page":"1858","article-title":"Unilateral cervical facet dislocation: injury mechanism and biomechanical consequences","volume":"27","author":"Crawford NR","year":"2002","unstructured":"Crawford NR, Duggal N, Chamberlain RH,  Unilateral cervical facet dislocation: injury mechanism and biomechanical consequences. Spine (Phila Pa 1976). 2002;27(17):1858\u20131864."},{"issue":"21","key":"b2","series-title":"Spine (Phila Pa 1976)","first-page":"2365","article-title":"The Subaxial Cervical Spine Injury Classification System: a novel approach to recognize the importance of morphology, neurology, and integrity of the disco-ligamentous complex","volume":"32","author":"Vaccaro AR","year":"2007","unstructured":"Vaccaro AR, Hulbert RJ, Patel AA,  The Subaxial Cervical Spine Injury Classification System: a novel approach to recognize the importance of morphology, neurology, and integrity of the disco-ligamentous complex. Spine (Phila Pa 1976). 2007;32(21):2365-2374."},{"issue":"1","key":"b3","series-title":"Orthop Clin North Am","first-page":"15","article-title":"A practical classification of acute cervical spine injuries","volume":"17","author":"Harris JH","year":"1986","unstructured":"Harris JH, Edeiken-Monroe B, Kopaniky DR. A practical classification of acute cervical spine injuries. Orthop Clin North Am. 1986;17(1):15\u201330."},{"issue":"1","key":"b4","series-title":"Spine (Phila Pa 1976)","first-page":"1","article-title":"A mechanistic classification of closed, indirect fractures and dislocations of the lower cervical spine","volume":"7","author":"Allen BL Jr","year":"1982","unstructured":"Allen BL Jr, Ferguson RL, Lehmann TR,  A mechanistic classification of closed, indirect fractures and dislocations of the lower cervical spine. Spine (Phila Pa 1976). 1982;7(1):1-27."},{"issue":"2","key":"b5","series-title":"Spine (Phila Pa 1976)","first-page":"97","article-title":"The impact of facet dislocation on clinical outcomes after cervical spinal cord injury: results of a multicenter North American prospective cohort study","volume":"38","author":"Wilson JR","year":"2013","unstructured":"Wilson JR, Vaccaro A, Harrop JS,  The impact of facet dislocation on clinical outcomes after cervical spinal cord injury: results of a multicenter North American prospective cohort study. 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Reduction of lower cervical facet dislocation: a review of all techniques. Neurospine. 2023;20(1):181\u2013204."},{"issue":"1","key":"b12","series-title":"J Clin Neurosci","first-page":"36","article-title":"Anterior versus combined anterior and posterior fixation\/fusion in the treatment of distraction-flexion injury in the lower cervical spine","volume":"15","author":"Song KJ","year":"2008","unstructured":"Song KJ, Lee KB. Anterior versus combined anterior and posterior fixation\/fusion in the treatment of distraction-flexion injury in the lower cervical spine. 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Biometrika. 1993;80(1):27\u201338."},{"issue":"16","key":"b22","series-title":"Stat Med","first-page":"2409","article-title":"A solution to the problem of separation in logistic regression","volume":"21","author":"Heinze G","year":"2002","unstructured":"Heinze G, Schemper M. A solution to the problem of separation in logistic regression. Stat Med. 2002;21(16):2409\u20132419."},{"issue":"10","key":"b23","series-title":"Medicina","first-page":"1005","article-title":"Identifying clinicoradiological phenotypes in diffuse idiopathic skeletal hyperostosis: a cross-sectional study","volume":"57","author":"Clavaguera T","year":"2021","unstructured":"Clavaguera T, Reyner P, Bux\u00f3 M,  Identifying clinicoradiological phenotypes in diffuse idiopathic skeletal hyperostosis: a cross-sectional study. 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Spine (Phila Pa 1976). 2002;27(17):1858\u20131864."},{"issue":"21","key":"b2","series-title":"Spine (Phila Pa 1976)","first-page":"2365","article-title":"The Subaxial Cervical Spine Injury Classification System: a novel approach to recognize the importance of morphology, neurology, and integrity of the disco-ligamentous complex","volume":"32","author":"Vaccaro AR","year":"2007","unstructured":"Vaccaro AR, Hulbert RJ, Patel AA,  The Subaxial Cervical Spine Injury Classification System: a novel approach to recognize the importance of morphology, neurology, and integrity of the disco-ligamentous complex. Spine (Phila Pa 1976). 2007;32(21):2365-2374."},{"issue":"1","key":"b3","series-title":"Orthop Clin North Am","first-page":"15","article-title":"A practical classification of acute cervical spine injuries","volume":"17","author":"Harris JH","year":"1986","unstructured":"Harris JH, Edeiken-Monroe B, Kopaniky DR. A practical classification of acute cervical spine injuries. Orthop Clin North Am. 1986;17(1):15\u201330."},{"issue":"1","key":"b4","series-title":"Spine (Phila Pa 1976)","first-page":"1","article-title":"A mechanistic classification of closed, indirect fractures and dislocations of the lower cervical spine","volume":"7","author":"Allen BL Jr","year":"1982","unstructured":"Allen BL Jr, Ferguson RL, Lehmann TR,  A mechanistic classification of closed, indirect fractures and dislocations of the lower cervical spine. Spine (Phila Pa 1976). 1982;7(1):1-27."},{"issue":"2","key":"b5","series-title":"Spine (Phila Pa 1976)","first-page":"97","article-title":"The impact of facet dislocation on clinical outcomes after cervical spinal cord injury: results of a multicenter North American prospective cohort study","volume":"38","author":"Wilson JR","year":"2013","unstructured":"Wilson JR, Vaccaro A, Harrop JS,  The impact of facet dislocation on clinical outcomes after cervical spinal cord injury: results of a multicenter North American prospective cohort study. Spine (Phila Pa 1976). 2013;38(2):97\u2013103."},{"issue":"3","key":"b6","series-title":"Spine J","first-page":"387","article-title":"Traumatic subaxial cervical facet subluxation and dislocation: epidemiology, radiographic analyses, and risk factors for spinal cord injury","volume":"18","author":"Quarrington RD","year":"2018","unstructured":"Quarrington RD, Jones CF, Tcherveniakov P,  Traumatic subaxial cervical facet subluxation and dislocation: epidemiology, radiographic analyses, and risk factors for spinal cord injury. Spine J. 2018;18(3):387\u2013398."},{"issue":"10","key":"b7","series-title":"Orthopedics","first-page":"917","article-title":"Management of unilateral facet dislocations: a review of the literature","volume":"20","author":"Andreshak JL","year":"1997","unstructured":"Andreshak JL, Dekutoski MB. Management of unilateral facet dislocations: a review of the literature. 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Spinal Cord Ser Cases. 2018;4(1):86."},{"issue":"2","key":"b10","series-title":"Int J Spine Surg","first-page":"256","article-title":"Awake cranial traction and isolated anterior cervical discectomy and fusion in the treatment of traumatic subaxial cervical facet joint dislocations: analysis of a cohort of 70 patients and predictors of surgical failure","volume":"16","author":"Sousa A","year":"2022","unstructured":"Sousa A, Rodrigues C, Marques M,  Awake cranial traction and isolated anterior cervical discectomy and fusion in the treatment of traumatic subaxial cervical facet joint dislocations: analysis of a cohort of 70 patients and predictors of surgical failure. Int J Spine Surg. 2022;16(2):256\u2013263."},{"issue":"1","key":"b11","series-title":"Neurospine","first-page":"181","article-title":"Reduction of lower cervical facet dislocation: a review of all techniques","volume":"20","author":"Liu K","year":"2023","unstructured":"Liu K, Zhang Z. Reduction of lower cervical facet dislocation: a review of all techniques. Neurospine. 2023;20(1):181\u2013204."},{"issue":"1","key":"b12","series-title":"J Clin Neurosci","first-page":"36","article-title":"Anterior versus combined anterior and posterior fixation\/fusion in the treatment of distraction-flexion injury in the lower cervical spine","volume":"15","author":"Song KJ","year":"2008","unstructured":"Song KJ, Lee KB. Anterior versus combined anterior and posterior fixation\/fusion in the treatment of distraction-flexion injury in the lower cervical spine. J Clin Neurosci. 2008;15(1):36\u201342."},{"issue":"6","key":"b13","series-title":"Clin Spine Surg","first-page":"261","article-title":"Cervical posttraumatic unilateral locked facets: clinical, radiologic, and surgical remarks on a series of 33 patients","volume":"29","author":"Piccirilli M","year":"2016","unstructured":"Piccirilli M, Liberati C, Santoro G,  Cervical posttraumatic unilateral locked facets: clinical, radiologic, and surgical remarks on a series of 33 patients. Clin Spine Surg. 2016;29(6):261\u2013265."},{"issue":"5","key":"b14","series-title":"Clin Spine Surg","first-page":"374","article-title":"The management of traumatic cervical bilateral facet fracture\u2013dislocations with unicortical anterior plates","volume":"13","author":"Razack N","year":"2000","unstructured":"Razack N, Green BA, Levi ADO. The management of traumatic cervical bilateral facet fracture\u2013dislocations with unicortical anterior plates. Clin Spine Surg. 2000;13(5):374\u2013381."},{"issue":"24","key":"b15","series-title":"Spine (Phila Pa 1976)","first-page":"2815","article-title":"The radiographic failure of single segment anterior cervical plate fixation in traumatic cervical flexion distraction injuries","volume":"29","author":"Johnson MG","year":"2004","unstructured":"Johnson MG, Fisher CG, Boyd M,  The radiographic failure of single segment anterior cervical plate fixation in traumatic cervical flexion distraction injuries. Spine (Phila Pa 1976). 2004;29(24):2815\u20132820."},{"issue":"2","key":"b16","series-title":"Neurosurgery","first-page":"388","article-title":"Anterior reduction and fusion of cervical facet dislocations","volume":"84","author":"Theodotou CB","year":"2019","unstructured":"Theodotou CB, Ghobrial GM, Middleton AL,  Anterior reduction and fusion of cervical facet dislocations. 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