Facet Dislocation

synonyms:

Facet Dislocation ICD-9

Facet Dislocation Etiology / Epidemiology / Natural History

• Unilateral dislocation are caused by axial loading and flexion-rotation. Generally have neurologic involvement.
• Bilateral: high association with quadriplegia

Facet Dislocation Anatomy

• .

Facet Dislocation Clinical Evaluation

• Palpate entire spine for tenderness / step off.
• Complete neuro exam: motor strength, pin-prick sensation, reflexes, cranial nerves, rectal examination (perineal pin-prick sensation, sphincter tone, volitional spincter control)
• Absence of the bulbocaverosus reflex indicates spinal shock. Level of spinal injury can not be determined until bulbocaverosus reflex has returned.
• See ASIA form.

Facet Dislocation Xray / Diagnositc Tests

• A/P, Lateral, Odontoid: .
• CT cervical spine:
• MRI:
• Unilateral: <50% anterior shift of the superior vertebra on the inferior vertebra on lateral view.
• Bilateral: >50% anterior shift of the superior vertebra on the inferior vertebra on lateral view.

Facet Dislocation Classification / Treatment

• Unilateral: attempted closed reduction; open reduction and posterior fusion if unsuccessful.
• Bilateral: attempted closed reduction; open reduction and posterior fusion if unsuccessful.
• Reduction: cranial tong traction in alert cooperative patients. Initial 10 lb of traction appliced and sequentially increased in 5lb increments with frequent neuro exams and repeat xrays. Reduction generally occurs before 70lbs of traction. Prereduction MRI remains controversial. Consider for neuroligically intact patients.

Facet Dislocation Associated Injuries / Differential Diagnosis

• Occipital Condyle Fracture
• Occipitocervical Dissociation
• Atlas fracture
• C2 fracture
• Odontoid fracture
• Burst Fracture
• Compression Fracture
• Spinal Cord Injury

Facet Dislocation Complications

Facet Dislocation Follow-up Care

• Stable closed reduction: 8-12 weeks in halo brace followed by 4 weeks of corrective bracing.

Facet Dislocation Review References