Cervical facet dislocation

Revision as of 09:07, 19 December 2015 by Kian (talk | contribs) (clinical features updated)

Background

Clinical Features

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

Differential Diagnosis

Vertebral fractures and dislocations types

Vertebral anatomy.

Workup

  • C-Spine X-Ray
  • determine if more than 1 spinal column affected
    • 1 column = generally stable
    • 2 or more columns = unstable
  • generally superior facet fx
  • 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

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

See Also