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What is a Cervical Facet Fracture or Dislocation?
A cervical facet injury is an injury to the back of the neck bones. There are a total of seven vertebre in the cervical spine, neighboring vertebre are connected in the front of the spine by sharing a vertebral disk (which can herniate and cause pain, see talk) and they are connected in the back by two facet joints. Between these front and back connections, there is a hole through the middle of each bone, and the hole lines up at each vertebre to form the spinal canal. This is where the spinal cord runs, from the head to the lower back, well protected by bone on all sides.
All joints are where two bones come together, and the facet joint, like any other joint, can dislocate if a significant force is applied. While the spine has facet joints at every vertebre, from the neck to the low back, 75% of facet dislocations occur in the neck because they typically occur from a distraction and hyperflexion force, which is most common from a whiplash injury when a persons head (which is pretty heavy) lurches forward during a motor vehicle collision. Every level of the spine has a left and a right facet joint, sometimes one side alone is broken or dislocated, and sometimes, with more severe injuries, both sides are affected.
How is a Cervical Facet Fracture or Dislocation diagnosed?
A facet dislocation or fracture is suspected in a patient that comes into the emergency room after a traumatic injury, like a motor vehicle collision. People with this injury complain of neck pain (particular with a unilateral facet injury) or neurologic problems (more commonly seen with a bilateral facet injury).
A Unilateral jump causes a 35% subluxation of one vertebre, while a bilateral jump is 50% subluxation. The larger the subluxation, the more significant risk for neurologic injury.
How is a Cervical Facet Fracture or Dislocation treated?
Treatment depends on the severity of injury and presence of nerve injury.
If the patient is neurologically ok, then an MRI is ordered to see if there is any nerve compression.
If the patient is has poor neurologic function, then rapid intervention is needed. There is no time for an MRI. The spine should be realigned through skeletal traction (stretching out the neck with weights). This can be performed in the emergency room with traction, and the patient needs to be awake to be able to say if theres improvement or worsening in neurologic status during the intervention.
Bilateral facet dislocation requires a fusion (fixing two vertebre together) because there is significant ligament injury after this dislocation. Fusion treats the spinal instability (instability could lead to a nerve injury in the future).
A Unilateral dislocation is often fused as well, however, some doctors feel they can heal with immobilization using a hard neck collar.
What is the long term outcome?
The patients do great when they are treated correctly.