Cervical facet dislocation

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Background

Clinical Features

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

Differential Diagnosis

Cervical Spine Fracture and Dislocation Types

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