Figure. Sagittal computed tomography of the cervical spine.
A 75-year-old woman presents to the emergency department with complaints of severe neck pain following a fall at home. She states that she fell forward and sustained a hyperflexion injury to her neck. Despite her injury, she is alert and cooperative. Sagittal computed tomography (CT) of the cervical spine (Figure) is obtained.
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The patient has sustained a bilateral facet joint dislocation at C6-C7, with 50% dislocation of the vertebral body as seen on CT. Cervical facet joint dislocation occurs when one vertebral body displaces over another.
Hyperflexion injury is the most common mechanism of injury to the neck and may cause bilateral facet dislocations.1 By comparison, hyperflexion with cervical rotation may cause a unilateral facet joint dislocation.1 The deformity can cause severe compression on the spinal cord resulting in complete or incomplete spinal cord injuries.
Management of cervical facet dislocations remains controversial. Treatment in an alert, cooperative patient most often involves immediate closed reduction, which is often performed under general anesthesia with cervical traction and intraoperative fluoroscopy. Once the facet joints have been reduced, MRI is often performed for preoperative planning. In an unconscious patient, MRI is often performed before closed reduction is performed.2
Once the dislocation is reduced, the need for cervical stabilization with an anterior or posterior surgical approach is widely accepted as the optimal definitive treatment.2,3
Dagan Cloutier, MPAS, PA-C, practices in a multispecialty orthopedic group in the southern New Hampshire region and is editor-in-chief of the Journal of Orthopedics for Physician Assistants (JOPA).
1. Raniga SB, Menon V, Al Muzahmi KS, Butt S. MDCT of acute axial cervical spine trauma: a mechanism-based approach. Insights Imaging. 2014;5(3):321-338.
2. Moore D. Cervical facet dislocations and fractures. OrthoBullets website. https://www.orthobullets.com/spine/2064/cervical-facet-dislocations-and-fractures. Updated September 16, 2019. Accessed October 29, 2019.
3. Miao D-C, Qi C, Wang F, Lu K, Shen Y. Management of severe lower cervical facet dislocation without vertebral body fracture using skull traction and an anterior approach. Med Sci Monit. 2018;24:1295-1302.