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 Fractures and Dislocations

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? β†’ get CT

Management

Prehospital Immobilization

See NAEMSP National Guidelines for Spinal Immobilization

Hospital

====Bilateral====

Bilateral facet dislocation: although there are no bony fractures, displacement of one vertebra over the inferior disturbs the spinal canal
  • 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

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) β€˜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