Management of Facet Joint Dislocation of Cervical Spine

Abstract

BACKGROUND Facet joint injuries are increasing day by day due to increase in road traffic accidents produced by rotation of head in flexion or extension. It commonly affects lower cervical spine due to anatomical considerations being a very mobile part between head and a fixed torso. The architecture of vertebra in lower cervical spine also predisposes to injury are combination of lower height, smaller anteroposterior diameter of the superior facet and a more horizontally oriented superior facet at C6 and C7 levels. 1 MATERIALS AND METHODS In our series of 19 cases, both unilateral and bilateral facet dislocation were taken into consideration either with or without fracture. Unilateral fracture dislocations were associated with less neurological deficit, but were difficult to reduce while bilateral fracture dislocations had more and many times permanent neurological deficit. Majority of our patients were treated by open reduction and internal fixation with Bohler's triple wiring and bone grafting to achieve fusion. RESULTS The goal of treatment is to preserve functional and anatomical continuity of spinal cord and nerve roots, restore spinal alignment, establish spinal stability and provide freedom from post injury pain or delayed neurological problem. In our series of 19 cases, 16 were treated operatively and they experienced better stability and pain relief. None of our cases showed post-treatment deterioration in neurological status. Improvement in neurological status was seen more in partial or incomplete loss cases, i.e. Franklin B or C. CONCLUSION Cervical facet fracture dislocations should be reduced, stabilised and fused as early as possible for better rehabilitation and chances of neurological recovery. Bohler's triple wiring seems to be cheap and reasonably good method of fixation.

Lower cervical trauma an orthopaedician domain

“…Usually facet capsules, the posterior longitudinal ligament, and the posterior anulusfibrosus and disc are disrupted. 4 These injuries are more frequently associated with neurological deficits than are unilateral facet dislocations. These dislocations are more easily reduced with closed traction methods than unilateral dislocations, but because they are so unstable, redislocation is frequent even if they are treated with prolonged skeletal traction.…”