Sub-Axial Cervical Facet Dislocation: A Review of Current Concepts

Abstract

Cervical facet dislocation is a serious injury that carries risks of short- and long-term morbidity. The optimal management of these injuries remains controversial with the ongoing debate regarding indications and requirements for closed reduction, timing, type of surgical approach and method of fixation. This review gives an update on the relevant anatomy, classification systems for sub-axial cervical facet dislocation and an overview of the current concepts regarding their management, including surgical approaches and the choice of implants.

Letter to the Editor: Is Anterior-Only Fixation Adequate for Three-Column Injuries of the Cervical Spine?

“…(4) The major risk factors for such failures after anterior-only stabilization include the presence of associated significant bony injuries (facet [>50%], lateral mass, or endplate fractures); osteoporosis; and ankylosing spondylitis [4]. These subsets of patients can have poorer surgical outcomes and higher chances of mechanical failure.…”

The classifications of subaxial cervical spine traumatic injuries. Part 6. Ben L. Allen biomechanical classification

“…До варіантів хірургічних доступів при однобічних або двобічних вивихах належать ізольований передній, задній, комбінований передньо-задній і етапний передньо-задньо-передній [40,41]. Вибір оптимального методу хірургічного втручання залежить від великої кількості чинників: ступеня нестабільності, наявності вентральної компресії, можливості відкритого непрямого вправляння тощо [42]. Переваги та недоліки різних хірургічних підходів розглянуто нами раніше [43].…”

Overview of Subaxial Cervical Spine Fractures and Dislocations

“…If a closed reduction is planned first, an MRI should be obtained first in recalcitrant patients with altered mental status to determine the health of the spinal cord as well as any disc or bone injury that could put the spinal cord at danger. It is still controversial whether an MRI should be performed before a closed reduction in an awake examinable patient [15].…”

“…Several studies, including those by Vaccaro et al, have suggested that closed reduction in an awake and conscious patient without a prereduction MRI may be safe. Closed reduction in sedated patients may be safe in most circumstances, according to several recent studies [15][16][17][18][19][20].…”

“…The pins were then placed just below the superior temporal line, avoiding the temporalis muscle and the artery. The newly developed Singhal traction bed uses a load cell tensioning handle to create incremental traction while flexing the cervical spine [15].…”