Unilateral Cervical Facet Dislocation in a 9-Year-Old Boy

Abstract

Facet dislocations in children are rare. This article presents the youngest case of a unilateral facet dislocation described in the pediatric population. A 9-year-old boy sustained a flexion/axial loading injury to his cervical spine while wrestling with his friends, causing a unilateral facet dislocation at C4/5. Prereduction magnetic resonance imaging (MRI) demonstrated the absence of a diskal herniation or cord impingement and an intact posterior ligamentous complex. Due to the patient's young age, the decision was made to forgo a supervised awake closed reduction. Closed reduction was performed under general anesthesia with somatosensory-evoked potential and motor-evoked potential monitoring. Closed reduction was successfully achieved after Gardner-Wells tongs were applied and used to manually direct slow, steady in-line traction, along with slight flexion and posterior rotation of the dislocated side under direct fluoroscopy. The patient was immediately awakened from anesthesia and was found to have an intact sensory examination. He was immobilized in a cervical collar for 12 weeks. At 2-year follow-up, he remained asymptomatic without recurrence and had painless full range of motion of the cervical spine. Radiographs revealed a normally aligned cervical spine. Unilateral cervical facet dislocations and subluxations are the result of a distractionflexion force applied to the spine along with a rotational component. These are not uncommon injuries in the adult spine; however, in the young pediatric population, cervical facet dislocations are rare.