Cervical facet dislocation

Background

• When bilateral, is an unstable spine injury

Vertebral fractures and dislocations types

Vertebral anatomy.

Numbering order of vertebrae.

• Cervical fractures and dislocations
  • Atlanto-occipital dissociation
  • C1
    • Jefferson fracture
    • C1 isolated anterior arch fracture
    • C1 isolated posterior arch fracture
  • C2
    • Odontoid fracture
    • Hangman's fracture
  • C3-C7
    • Cervical burst fracture
    • Cervical spinous process fracture
    • Extension cervical teardrop fracture
    • Flexion cervical teardrop fracture
    • Anterior cervical wedge fracture
  • Cervical facet dislocation
  • Isolated transverse process fracture
• Thoracic and lumbar fractures and dislocations
  • Chance fracture
  • Thoracic burst fracture
  • Lumbar burst fracture
  • Isolated transverse process fracture
  • Thoracic and lumbar compression fractures

Clinical Features

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

Differential Diagnosis

Neck Trauma

• Penetrating neck trauma
• Blunt neck trauma
  • Vertebral and carotid artery dissection
  • Strangulation
  • Whiplash injury
• Cervical injury
  • Cervical fractures and dislocations
  • Cervical injury (peds)
  • Cervical spine clearance
• Neurogenic shock
• Spinal cord injury

Evaluation

• C-Spine X-Ray
• 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

• Spinal Cord Trauma
• Cervical spine injuries