Bilateral Cervical Facet Dislocation Research Articles

Management of Misdiagnosed Bilateral Cervical Facet Dislocation: A Case Report

Background: Despite improvement in technology and decision-making, misdiagnosis or delayed diagnosis of cervical spine injuries in trauma patients can cause severe irreparable neurological damage.
 Case Report: We present here a 56-year-old man, with a history of old bilateral C4-C5 dislocation who, contrarily to classically described unfavorable results of cranial traction in patients with older than 3 weeks cervical injury, underwent optimal reduction under cranial traction for four days and surgical intervention with an anterior surgical approach.
 Conclusion: Relatively high incidence of missed cervical spine injuries in polytrauma patients illustrates that proper clinical examination, use of designed protocols for clearance of cervical trauma, and accurate interpretation of radiological imaging can sometimes be neglected.

Investigating the Effect of Axial Compression and Distraction on Cervical Facet Mechanics During Supraphysiologic Anterior Shear.

Bilateral cervical facet dislocation (BFD) with facet fracture (Fx) often causes tetraplegia but is rarely recreated experimentally, possibly due to a lack of muscle replication. Intervertebral axial compression (due to muscle activation) or distraction (due to inertial loading), when combined with excessive anterior translation, may influence interfacet contact or separation and the subsequent production of BFD with or without Fx. This paper presents a methodology to produce C6/C7 BFD+Fx using anterior shear motion superimposed with 300 N compression or 2.5 mm distraction. The effect of these superimposed axial conditions on six-axis loads, and C6 inferior facet deflections and surface strains, was assessed. Twelve motion segments (70 ± 13 yr) achieved 2.19 mm of supraphysiologic anterior shear without embedding failure (supraphysiologic shear analysis point; SSP), and BFD+Fx was produced in all five specimens that reached 20 mm of shear. Linear mixed-effects models (α = 0.05) assessed the effect of axial condition. At the SSP, the compressed specimens experienced higher axial forces, facet shear strains, and sagittal facet deflections, compared to the distracted group. Facet fractures had similar radiographic appearance to those that are observed clinically, suggesting that intervertebral anterior shear motion contributes to BFD+Fx.

Bilateral cervical facet dislocations at two adjacent levels: A case report

Background:Cervical facet dislocations are rare in patients sustaining traumatic subaxial injuries. They occur due to hyperflexion-distraction and can occur unilaterally or bilaterally resulting in significant spinal instability. Bilateral facet dislocations at one level are less common than unilateral dislocations, while bilateral facet dislocations at adjacent spinal levels have only been reported twice in literature.Case Description:A 31-year-old male presented with bilateral facet dislocations at two adjacent cervical levels (C6/C7 and C7/T1) following a fall from 40 to 50 feet. The patient had undergone a C6/C7 disk arthroplasty a few weeks before the traumatic event.Conclusion:Here, we present the unique case of cervical bilateral jumped facets occurring at two adjacent levels (i.e., C6–C7 and C7–T1). Notably, the antecedent cervical C6–C7 arthroplasty likely contributed to the altered load distribution, leading to this unusual instance of bilateral adjacent level facet dislocations. In such cases, surgical reduction and fixation may prove technically challenging warranting, therefore, careful preoperative planning.

Poster 145 Delayed Diagnosis of Bilateral Cervical Facet Dislocation: A Case Report

PM&RVolume 7, Issue 9S p. S139-S139 Pain and Spine Medicine Poster 145 Delayed Diagnosis of Bilateral Cervical Facet Dislocation: A Case Report Anupam Sinha DO, Anupam Sinha DO Rothman Institute, Philadelphia, PA, United StatesSearch for more papers by this authorMadhuri Dholakia MD, Madhuri Dholakia MD Rothman Institute, Philadelphia, PA, United StatesSearch for more papers by this author Anupam Sinha DO, Anupam Sinha DO Rothman Institute, Philadelphia, PA, United StatesSearch for more papers by this authorMadhuri Dholakia MD, Madhuri Dholakia MD Rothman Institute, Philadelphia, PA, United StatesSearch for more papers by this author First published: 08 September 2015 https://doi.org/10.1016/j.pmrj.2015.06.183Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume7, Issue9SSeptember 2015Pages S139-S139 RelatedInformation

Subacute Posttraumatic Ascending Myelopathy After Excessive Closed Reduction of Bilateral Cervical Facet Dislocation

Subacute Posttraumatic Ascending Myelopathy After Excessive Closed Reduction of Bilateral Cervical Facet Dislocation

Bilateral Facet Dislocation with Neural Compression from an Avulsed Posterior Longitudinal Ligament

Background and Importance: A review of the literature failed to show evidence of normal appearing posterior longitudinal ligament avulsion as a cause of spinal cord compression after bilateral cervical facet dislocations. We report a case of the posterior longitudinal ligament (PLL) avulsion causing spinal cord compression after bilateral cervical facet dislocation. Clinical presentation: A 93 year female presented with upper extremity numbness and bilateral C5-C6 facet dislocations. The patient was immediately taken for closed reduction and anterior cervical decompression with fusion (ACDF). After awake, closed reduction, an ACDF was immediately performed. After a complete discectomy procedure, the spinal cord could be visualized secondary to an absent PLL. A nerve hook was used to explore behind the C6 vertebral body to decompress the spinal cord. A segment of normal appearing posterior longitudinal ligament, which had avulsed from the superior aspect of C5, was found folded behind the C6 vertebra causing cord compression. There was no herniated disk material discovered. Conclusion: In addition to herniated disk material, avulsed PLL is another potential source of cord compression after closed reduction of cervical facet dislocations and surgeons must be aware of this possible source of compression while exploring and decompressing the spinal canal. This case study elucidates that the PLL is a potential cause of spinal cord compression after traumatic bilateral cervical facet dislocations.

Treatment of traumatic spondylolisthesis of the lower cervical spine with concomitant bilateral facet dislocations: Risk of respiratory deterioration

BackgroundThis study aimed to retrospectively examine 36 cases of bilateral cervical facet dislocations (BCFD) of the lower cervical spine who were at risk for respiratory deterioration. MethodsThe cases of 36 subjects with BCFD of the lower cervical spine who failed to achieve closed reduction were retrospectively studied. The extents of neurological injuries included posterior neck pain without neurological deficit (n=2), incomplete spinal cord injury (ISCI) (n=21), and complete spinal cord injury (CSCI) (n=13). ResultsAmong the subjects, 26 (72.22%) had dyspnea, 6 required mechanical ventilation due to respiratory muscle paralysis, 11 required tracheostomy, and 9 required intubation. All patients received posterior approach reduction, stabilization, and fusion treatment for BCFD in one operative session. For the 26 quadriparetic patients with dyspnea, priority was given to treating their respiratory problems. For the other 10 patients without dyspnea, surgical treatment for irreducible lower cervical spine dislocation was given priority. After an average follow-up period of 63 months, 21 complications were found, but all patients exhibited fusion. Twenty-one patients with ISCI exhibited improvements in their conditions of 1 or 2 grades on the American Spinal Injury Association scale, whereas those with CSCI did not improve. All 26 apnea cases improved. The majority (26) of the 36 cases with BCFD of the lower cervical spine suffered dyspnea. ConclusionsAlthough further study is required, our study suggests that the posterior surgical approach to the cervical spine is safe and effective for patients with traumatic spondylolisthesis of the lower cervical spine concomitant with BCFD who are at risk of respiratory deterioration.

Delayed surgical treatment for a traumatic bilateral cervical facet joint dislocation using a posterior-anterior approach: a case report

IntroductionThere have been few reports of patients with bilateral cervical facet dislocations that remain untreated for eight weeks or more. We report the case of a 76-year-old man with an old bilateral cervical facet joint dislocation fracture that was treated by posterior-anterior reduction and fixation.Case presentationA 76-year-old Asian man was involved in a road traffic accident. He presented with neck pain and arm pain on his right side, but motor weakness and paralysis were not observed. He was treated conservatively; however, instability and spondylolisthesis at the C5 to C6 joint increased eight weeks after the injury. We performed a posterior-anterior reduction and fixation. After surgery, bony union was achieved, and his neck pain and arm pain disappeared.ConclusionWe recommend reduction and fixation surgery if a patient has an old bilateral facet joint dislocation fracture in the cervical spine.

Delayed Presentation of Cervical Facet Dislocations

To review treatment outcomes of 19 patients with delayed presentation of cervical facet dislocations. Records of 17 men and 2 women aged 21 to 63 (mean, 39) years who presented with unilateral (n=14) or bilateral (n=5) cervical facet dislocation after a delay of 7 to 21 (mean, 14) days were reviewed. The most common level of dislocation was C5-C6 (n=9), followed by C4-C5 (n=6), C3- C4 (n=2), and C6-C7 (n=2). The neurological status was graded according to the Frankel classification. One patient (with bilateral facet dislocation) had complete quadriplegia (grade A), 11 had incomplete spinal cord injury (grades C and D), and 7 had nerve root injury. Closed reduction using continuous skull traction for 2 days was attempted. In patients achieving closed reduction, only anterior discectomy and fusion was performed. Those who failed closed reduction underwent posterior partial/complete facetectomy and fixation. If there was traumatic disk prolapse, anterior decompression and fusion was then performed. The mean follow-up was 46 (range, 12- 108) months. 10 of 14 patients with unilateral facet dislocation were reduced with traction and then underwent anterior discectomy and fusion. The remaining 4 patients who failed closed reduction underwent posterior facetectomy and fixation; 3 of them had traumatic disk prolapse and thus also underwent anterior discectomy and fusion with cage and plate. Four of the 5 patients with bilateral facet dislocations failed closed reduction and underwent posterior facetectomy and lateral mass fixation, as well as anterior surgery. The remaining patient achieved reduction after traction and hence underwent only anterior discectomy and fusion. All patients achieved pain relief and sufficient neck movement for normal activities. All 7 patients with nerve root injury improved completely; 9 of the 11 patients with incomplete spinal cord injury improved by one Frankel grade, and the remaining 2 by 2 grades. The patient with complete quadriplegia showed no improvement. Preoperative traction is a safe and effective initial treatment for neglected cervical facet dislocation, as it reduces the need for extensive (anterior and posterior) surgery. If closed reduction is successful, anterior discectomy and fusion is the surgery of choice. If not, posterior facetectomy and fusion followed by anterior surgery is preferred.

Management of Cervical Facet Dislocations

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.

Treatment of bilateral cervical facet dislocation by reduction through anterior distraction

To investigate the effect of reduction through anterior distraction in treatment of bilateral cervical facet dislocation. Twenty-one patients with bilateral cervical facet dislocation underwent leverage reduction through anterior distraction, interbody fusion, and internal fixation. Follow-up lasted 16 months (4 months to 5 years). All of the 21 patients got reduction of cervical facet dislocation and bony fusion. The neurological deficiency in 4 of the 21 patients improved. Simple and safe, reduction through anterior distraction is effective in treatment of bilateral cervical facet dislocation with reliable fusion.

Delayed surgical management of a traumatic bilateral cervical facet dislocation by an anterior–posterior–anterior approach

Delayed diagnosis (more than one month after injury) of a bilateral cervical facet dislocation is exceptional, and delayed treatment is different from treatment in the acute stage. We describe a neurologically intact 51-year-old patient, in whom the diagnosis of bilateral cervical facet dislocation at C5/6 was made 10 weeks after the trauma. An anterior–posterior–anterior approach was performed, with repositioning during the posterior approach, and with anterior and posterior C5/6 fixation. The patient remained neurologically intact, and radiographic fusion was observed 3, 6, and 12 months postoperatively. Additionally, the (English) literature is reviewed and discussed.

The Radiographic Failure of Single Segment Posterior Cervical Instrumentation in Traumatic Cervical Flexion Distraction Injuries

Background/Objectives: Unilateral and bilateral cervical facet subluxations, dislocations, and/or fractures may be managed with anterior, posterior, or combined surgical approaches. The primary objective of this study was to identify radiographic features that predispose to poor radiographic outcomes (kyphosis) when these injuries are treated with single segment posterior cervical instrumentation and fusion. Method: A retrospective radiographic review was performed on 65 patients whose unilateral or bilateral facet subluxation/dislocations or fracture dislocation was managed with single segment posterior cervical instrumentation and fusion. The pre- and postoperative plain radiographs, CT, and MRI were assessed to identify the fracture type, degree of kyphosis, translation, and radiographic failure. Results: 2 patients (3.5%) demonstrated gross radiographic failure of the posterior instrumentation. Both had bilateral facet subluxation without fracture and ultimately required anterior revision. Kyphosis at...

Posterior longitudinal ligament status in cervical spine bilateral facet dislocations

It is generally accepted that cervical spine bilateral facet dislocation results in complete disruption of the posterior longitudinal ligament. The goal of this study was to evaluate the integrity of numerous spine-stabilizing structures by MRI, and to determine if any associations between injury patterns exist with respect to the posterior longitudinal ligament status. Retrospective case series. A retrospective review was performed of 30 cervical spine injury subjects with bilateral facet dislocation. Assessment of 1.5T MRI images was carried out for: intervertebral disc disruption, facet fracture, and ligamentous disruption. Statistical analyses were performed to evaluate for associations between various injury patterns and posterior longitudinal ligament status. The frequency of MRI abnormalities was: anterior longitudinal ligament disruption (26.7%), disc herniation or disruption (90%), posterior longitudinal ligament disruption (40%), facet fracture (63.3%) and disruption of the posterior column ligament complex (97%). There were no significant associations between injury to the posterior longitudinal ligament and other structures. Compared to surgical reports, MRI was accurate for determining the status for 24 of 26 ligaments (three of three anterior longitudinal ligament, seven of nine posterior longitudinal ligament, and 14 of 14 posterior column ligament complex) but generated false negatives in two instances (in both MRI showed an intact posterior longitudinal ligament that was torn at surgery). In contradistinction to the existing concept, the posterior longitudinal ligament can remain intact in a substantial proportion of hyperflexion injuries that produce bilateral cervical facet dislocation. Posterior longitudinal ligament integrity is not associated with any other injury pattern related to the anterior longitudinal ligament, intervertebral disc or facet fracture.

Acute Quadriplegia Following Closed Traction Reduction of a Cervical Facet Dislocation in the Setting of Ossification of the Posterior Longitudinal Ligament

A case report of acute quadriplegia resulting from closed traction reduction of traumatic bilateral cervical facet dislocation in a 54-year-old male with concomitant ossification of the posterior longitudinal ligament (OPLL). To report an unusual presentation of a spinal cord injury, examine the approach to reversal of the injury, and review the treatment and management controversies of acute cervical facet dislocations in specific patient subgroups. The treatment of acute cervical facet dislocations is an area of ongoing controversy, especially regarding the question of the necessity of advanced imaging studies before closed traction reduction of the dislocated cervical spine. The safety of an immediate closed, traction reduction of the cervical spine in awake, alert, cooperative, and appropriately select patients has been reported in several studies. To date, there have been no permanent neurologic deficits resulting from awake, closed reduction reported in the literature. A case of temporary, acute quadriplegia with complete neurologic recovery following successful closed traction reduction of a bilateral cervical facet dislocation in the setting of OPLL is presented. The clinical neurologic examination, radiographic, and advanced imaging studies before and after closed, traction reduction of a cervical facet dislocation are evaluated and discussed. A review of the literature regarding the treatment of acute cervical facet dislocations is presented. Radiographs showed approximately 50% subluxation of the fifth on the sixth cervical vertebrae, along with computerized tomography revealing extensive discontinuous OPLL. The cervical facet dislocation was successfully reduced with an awake, closed traction reduction, before magnetic resonance imaging (MRI) evaluation. The patient subsequently had acute quadriplegia develop, with the ensuing MRI study illustrating severe spinal stenosis at the C5, C6 level as a result of OPLL or a large extruded disc herniation. Following an immediate anterior decompression and a posterior stabilization procedure, the patient regained full motor and sensory function. This case report highlights the advantages and shows some safety concerns regarding immediate, closed traction reduction of cervical facet dislocation with real-time neural monitoring in an awake, alert, oriented, and appropriately select patient before MRI studies in the setting of preexisting central stenosis from OPLL.

Magnetic resonance imaging analysis of soft tissue disruption after flexion-distraction injuries of the subaxial cervical spine.

A retrospective study was performed with the use of magnetic resonance imaging to evaluate the type and degree of soft tissue disruption associated with flexion-distraction injuries of the subaxial spine. To determine what soft tissue structures are injured in flexion-distraction injuries of the subaxial spine. Prior published reports of unilateral and bilateral cervical facet dislocations have described the analyzed mechanisms and biomechanics of this injury subtype. No retrospective magnetic resonance imaging analysis of associated soft tissue disruption has been documented. Magnetic resonance imaging evaluations of the cervical spine were obtained for all patients with a flexion-distraction injury, Stages 2 (unilateral facet dislocation) and 3 (bilateral facet dislocation), between September 1994 and May 1998. Two neuroradiologists, blinded to both clinical and radiographic findings, graded all the soft tissue structures for evidence of attenuation or disruption. The soft tissue structures were graded on a scale of 1 (intact), 2 (indeterminate), or 3 (disrupted). For this study, 48 patients satisfied the inclusion criteria: 25 with unilateral facet dislocation and 23 with bilateral facet dislocation. Disruption to the posterior musculature, interspinous ligament, supraspinous ligament, facet capsule, ligamentum flavum, and posterior and anterior longitudinal ligaments was found in a statistically significant number of patients with bilateral facet dislocation. For most of these structures, disruption was found to be statistically significant in patients with a unilateral facet dislocation, except for the posterior longitudinal ligament, in which significance was not consistently demonstrated using 95% confidence intervals in the binomial testing. In a comparison between unilateral and bilateral facet dislocations using a two-sided Fisher's exact test, it was found that disruption to the anterior and posterior longitudinal ligaments and the left facet capsule were statistically significant, with all three more prominent in bilateral facet dislocation. A multivariate analysis between unilateral and bilateral facet dislocations showed that disruption to the anterior longitudinal ligament was associated significantly with a bilateral facet dislocation. Disc disruption was found to be associated significantly with both injury types, but was more common in bilateral facet dislocation, although this difference in intergroup comparisons was not statistically significant. Unilateral and bilateral facet dislocations of the subaxial spine are associated with damage to numerous soft tissue structures that provide stability to the lower cervical spine. Damage to the posterior longitudinal ligament did not occur consistently in unilateral facet dislocations. Bilateral facet dislocations were associated significantly with disruption to the posterior and anterior longitudinal ligaments and left facet capsule, as compared with unilateral facet dislocations. Magnetic resonance imaging allows visualization of these disruptions.

Cervical facet dislocation: techniques for ventral reduction and stabilization

To demonstrate the safety and utility of one surgical approach, the authors reviewed their experience with the ventral surgical approach for decompression, reduction, and stabilization in 10 patients with either unilateral or bilateral cervical facet dislocation. Six patients presented with unilateral cervical facet dislocation and four patients with bilateral cervical facet dislocation. There were six male and four female patients who ranged in age from 17 to 72 years (average 37.1 years). The level of facet dislocation was C4-5 in one, C5-6 in four, and C6-7 in five patients. Three patients presented with a complete spinal cord injury (SCI), three patients with an incomplete SCI, three with radicular symptoms or myeloradiculopathy, and one patient was neurologically intact. All patients underwent plain radiography, magnetic resonance imaging, and computerized tomography evaluation of the cervical spine. All patients had sustained significant ligamentous injury with minimum or no bone disruption. All patients underwent ventral decompressive surgery, reduction of the dislocation, and stabilization of the cervical spine. Techniques for performing ventral reduction of unilateral or bilateral cervical facet dislocation are described. Decompression, reduction, and stabilization of the cervical spine via the ventral approach was accomplished in all but one patient. This patient underwent a ventral decompressive procedure and an attempt at ventral reduction and subsequent dorsal reduction and fusion in which a lateral mass screw plate fixation system was used; this was followed by ventral placement of instrumentation and fusion. There were no surgery-related complications. Postoperative neurological status was unchanged in four patients and improved in six patients. No patient experienced neurological deterioration after undergoing this surgical approach. The authors conclude that a ventral surgical decompression, reduction, and stabilization procedure provides a safe and effective alternative for the treatment of patients with unilateral or bilateral cervical facet dislocation without significant bone disruption.