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Cervical facet dislocation
From WikEM
Contents
Background
- When bilateral, is an unstable spine injury
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
- Atlanto-occipital dissociation
- C1
- C2
- C3-C7
- Cervical facet dislocation
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? → get CT
Management
Prehospital Immobilization
See NAEMSP National Guidelines for Spinal Immobilization
Hospital
Bilateral
- 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
- ↑ Diaz, J. J., Aulino, J. M., Collier, B. R., Roman, C. D., May, A. K., Miller, R. S. and Guillamondegui, O. D. (2004) ‘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
