Traumatic Bilateral Thoracic Facet Dislocation Without Fracture

Abstract

46-year-old man presented with complaints of severe back nd chest pain after a 2,000-lb construction disc fell on him at is worksite. Initial neurosurgical consultation was without ocal findings. CT scan of the spine revealed bilateral T4-T5 acet dislocation with 50% canal compromise (A–D). No asociated spine fracture was noted. MRI (E, F) demonstrated he facet dislocation (F, arrowheads), but failed to disclose vidence of a spinal cord contusion or traumatic disc herniaion. The patient had open reduction and internal fixation of he facet dislocation via frameless stereotaxic-guided pedicle crew fixation (G–J). Postoperatively he remained neurologially stable and continues to do well at his 18-month ollowup. Traumatic bilateral facet dislocation of the thoracic spine is rare clinical entity. It is thought to result from severe flexion nd distractive forces exerted on the spine at the time of imact. The majority of patients suffering a bilateral thoracic acet dislocation present with severe neurologic deficit, verteral fractures, and associated visceral injury. Interestingly, this atient is the only individual reported to have suffered bilatral thoracic facet dislocation without evidence of a fracture at he level of subluxation. Given that the thoracic facets are quite long and that the mount of weight required to attempt closed reduction would e prohibitive, previous authors have advocated open reducion and internal fixation with hook-rod constructs for the tabilization of this injury. By using neuronavigation we ere able to safely and rapidly perform thoracic pedicle screw ixation in this patient. Compared with hook-based systems, edicle screw constructs offer greater pullout strength, permit horter fusion length, and do not place instrumentation ithin the spinal canal.