Difference between revisions of "Cervical facet dislocation"

(edited for content)
(Differential Diagnosis)
 
(17 intermediate revisions by 9 users not shown)
Line 1: Line 1:
 
==Background==
 
==Background==
 
*When bilateral, is an [[unstable spine fractures|unstable spine injury]]
 
*When bilateral, is an [[unstable spine fractures|unstable spine injury]]
 +
 +
{{Vertebral fractures and dislocations types}}
  
 
==Clinical Features==
 
==Clinical Features==
 
*Generally from hyperflexion mechanism such as rapid deceleration
 
*Generally from hyperflexion mechanism such as rapid deceleration
*Frequently associated with spinal cord injury
+
*Frequently associated with [[Spinal cord syndromes|spinal cord injury]] when bilateral
  
 
==Differential Diagnosis==
 
==Differential Diagnosis==
{{Cervical spine injuries}}
+
{{Blunt neck trauma DDX}}
  
==Workup==
+
==Evaluation==
*[[C-Spine X-Ray]]
+
*[[C-Spine X-Ray]]<ref>Diaz, J. J., Aulino, J. M., Collier, B. R., Roman, C. D., May, A. K., Miller, R. S. and Guillamondegui, O. D. (2004) ‘THE EARLY WORK-UP FOR ISOLATED LIGAMENTOUS INJURY OF THE CERVICAL SPINE: DOES CT-SCAN HAVE A ROLE?’, The Journal of Trauma: Injury, Infection, and Critical Care, 57(2), p. 453</ref>
 
*determine if more than 1 spinal column affected  
 
*determine if more than 1 spinal column affected  
** 1 column = generally stable  
+
**1 column = generally stable  
** 2 or more columns = unstable
+
**2 or more columns = unstable
*generally superior facet fx
+
*generally superior facet fracture
*abnormal xray? -> get CT
+
*abnormal xray? get CT
  
 
==Management==
 
==Management==
Line 24: Line 26:
 
====Bilateral====
 
====Bilateral====
 
*Unstable as whole column can sublux
 
*Unstable as whole column can sublux
*high risk for significant spinal cord injury  
+
*High risk for significant spinal cord injury  
 
*Disruption of annulus fibrosus and ant longitudinal ligament > ant displacement of spine
 
*Disruption of annulus fibrosus and ant longitudinal ligament > ant displacement of spine
 
*Imaging
 
*Imaging
 
**Lateral xray: vertebral body will be displaced ~50% of its width  
 
**Lateral xray: vertebral body will be displaced ~50% of its width  
 
*Management
 
*Management
**spinal precautions
+
**Spinal precautions
**operative management: nsg vs ortho
+
**Operative management: nsg vs ortho
 +
[[File:Bilateral Facet Dislocation.jpg|right|thumbnail|Bilateral facet dislocation: although there are no bony fractures, displacement of one vertebra over the inferior disturbs the spinal canal]]
  
 
====Unilateral====
 
====Unilateral====
Line 43: Line 46:
  
 
==Disposition==
 
==Disposition==
 +
*Unilateral Facet Dislocation
 +
**Given stability can be placed in a cervical collar and follow up with neurosurgery as an outpatient
 +
*Bilateral Facet Dislocation
 +
**Emergent neurosurgical evaluation
  
 
==See Also==
 
==See Also==
 
*[[Spinal Cord Trauma]]
 
*[[Spinal Cord Trauma]]
 
*[[Cervical spine injuries]]
 
*[[Cervical spine injuries]]
 +
 +
==References==
 +
<references/>
  
 
[[Category:Trauma]]
 
[[Category:Trauma]]
[[Category:Ortho]]
+
[[Category:Orthopedics]]

Latest revision as of 13:18, 24 October 2020

Background

Vertebral fractures and dislocations types

Vertebral anatomy.

Clinical Features

  • Generally from hyperflexion mechanism such as rapid deceleration
  • Frequently associated with spinal cord injury when bilateral

Differential Diagnosis

Neck Trauma

Evaluation

  • C-Spine X-Ray[1]
  • determine if more than 1 spinal column affected
    • 1 column = generally stable
    • 2 or more columns = unstable
  • generally superior facet fracture
  • abnormal xray? → get CT

Management

Prehospital Immobilization

See NAEMSP National Guidelines for Spinal Immobilization

Hospital

Bilateral

  • Unstable as whole column can sublux
  • High risk for significant spinal cord injury
  • Disruption of annulus fibrosus and ant longitudinal ligament > ant displacement of spine
  • Imaging
    • Lateral xray: vertebral body will be displaced ~50% of its width
  • Management
    • Spinal precautions
    • Operative management: nsg vs ortho
Bilateral facet dislocation: although there are no bony fractures, displacement of one vertebra over the inferior disturbs the spinal canal

Unilateral

  • Relatively Stable
  • Presentation
    • C5/C6: C6 radiculopathy with weakness to wrist extension numbness and tingling in the thumb
    • C6/C7: C7 radiculopathy with weakness to triceps and wrist flexion and numbness in index and middle finger
  • Imaging
    • Lateral x-ray: vertebral body will be displaced ~25% of its width
    • Anterior x-ray: affected spinous process points toward side that is dislocated
  • Spinal cord injury rarely occurs

Disposition

  • Unilateral Facet Dislocation
    • Given stability can be placed in a cervical collar and follow up with neurosurgery as an outpatient
  • Bilateral Facet Dislocation
    • Emergent neurosurgical evaluation

See Also

References

  1. Diaz, J. J., Aulino, J. M., Collier, B. R., Roman, C. D., May, A. K., Miller, R. S. and Guillamondegui, O. D. (2004) ‘THE EARLY WORK-UP FOR ISOLATED LIGAMENTOUS INJURY OF THE CERVICAL SPINE: DOES CT-SCAN HAVE A ROLE?’, The Journal of Trauma: Injury, Infection, and Critical Care, 57(2), p. 453