Management of Cervical Facet Dislocations

Abstract

Optimal management of unilateral and bilateral cervical facet fractures remains controversial. This article explores the evaluation and treatment options available, focusing on the controversy surrounding prereduction magnetic resonance imaging (MRI) and the choice of surgical approach. In addition, the authors propose a treatment protocol for cervical facet dislocations. Acute disk herniation and disruption is highly prevalent in traumatic cervical facet injury. Some authors maintain the necessity of prereduction MRI to identify those at risk for further prolapse of a herniated disk during closed reduction maneuvers. Others maintain the risk of neurologic deterioration is small in the appropriate patient. To date, no permanent neurological worsening has ever been documented following a closed cervical spine reduction in an awake, cooperative patient. The need for open internal fixation following reduction is widely accepted; however, surgical treatment options are diverse and include anterior, posterior, and combined approaches. Closed reduction of cervical facet dislocations without baseline MRI is appropriate in the awake, cooperative patient. Postreduction MRI is essential in identifying herniated disks and tailoring a surgical approach. An anterior approach is classically employed with a concurrent disk herniation, although a combined anterior and posterior approach is sometimes chosen due to the severity of ligamentous disruption associated with bilateral cervical facet dislocations.