Management of Unilateral Facet Dislocation of the Cervical Spine.

Baek, Geum Seong; Lee, Woo Jong; Koh, Eun Jeong; Choi, Ha Young; Eun, Jong Pil

Original Article

Journal of Korean Neurosurgical Society 2007;41(5): 295-300.

Geum Seong Baek, Woo Jong Lee, Eun Jeong Koh, Ha Young Choi, Jong Pil Eun

Department of Neurosurgery, Research Institute of Clinical Medicine, Chonbuk National University Medical School and Hospital, Jeonju, Korea. jp-eun@hanmail.net

ABSTRACT

OBJECTIVE
Unilateral facet dislocation of the cervical spine occurs by flexion and rotation injuries and cannot be easily reduced by axial traction. We analyzed 14 consecutive patients with unilateral facet dislocation of the cervical spine to increase knowledge about anatomical reduction of locked facet and factors for successful reduction.
METHODS
Fourteen patients (10 men and 4 women) with unilateral facet dislocation of the cervical spine were retrospectively analyzed. Plain X-ray, computerized tomography scan, and magnetic resonance imaging were performed. All patients underwent manual reduction and surgery with anterior interbody fusion and plate fixation. The manual reduction was performed by neck flexion and rotation to the opposite side of dislocation, followed by rotation and flexion of the head toward the side of dislocation and extension with relaxation of traction. Mean follow-up period was 17 months. The level of spine, amount of subluxation, combined facet fracture, and time from injury to initial reduction were analyzed using the data obtained from medical records.
RESULTS
Thirteen (93%) patients were reduced successfully. Immediate reduction was achieved in 7 patients but failed in 7 patients. Seven patients underwent delayed closed reduction under general anesthesia, and successful reduction was achieved in 6 patients. Only one patient with bone chips between articular facets failed to achieve anatomical reduction.
CONCLUSION
In order to reduce the locked facet more easily and safely, we recommend manipulative traction with anterior interbody fusion and plate fixation under general anesthesia after being aware of spinal cord injury with magnetic resonance imaging.

Key Words: Dislocation; Locked facet reduction; Fusion