Magnetic Resonance Imaging in Cervical Facet Dislocation: A Third World Perspective

Abstract

Study DesignRetrospective case series.PurposeThe objective of our study was to determine the change in management brought about by magnetic resonance imaging (MRI) of the cervical spine in alert and awake patients with facet dislocation and spinal cord injury presenting within 4 hours after injury.Overview of LiteratureSpinal cord injury is a common clinical entity. The role of MRI is well established in evaluating spinal trauma. However, the time at which MRI should be used is still controversial.MethodsRetrospective data from 2002-2010 was evaluated. All of the alert and awake patients with spinal cord injury, based on clinical examination with facet dislocation diagnosed on lateral cervical spine X-rays, were included. A questionnaire was also conducted, the data of which consisted of demographic details including age and sex, the mechanism of injury, clinical examination, X-ray findings, MRI findings, whether or not surgery was performed and the time elapsed since injury. Data was analyzed using SPSS ver. 17.0. Continuous variables such as age were expressed in terms of mean ± standard deviation. Categorical variables such as change in management, X-ray/MRI findings and neurological motor level were assessed in terms of percentage.ResultsFifty patients participated in our study. All these patients had spinal cord injury with defined motor levels. The mean age was 35.5 ± 8.95 years (range, 20 to 52 years). Fifty percent showed a motor level at C6 level. None of the patients required any change in management based on the MRI.ConclusionsMRI of the spine in awake patients within 4 hours after injury does not change the management of patients. However, we can hypothesize that such patients can proceed to traction without waiting for the MRI.

Management of Severe Lower Cervical Facet Dislocation without Vertebral Body Fracture Using Skull Traction and an Anterior Approach

“…The open reduction can be achieved through an anterior approach alone, a posterior approach alone, or a combined anterior and posterior approach as the surgical approach is not standardized [ 19 ]. The increased use of an anterior approach has meant that this indication is no longer limited to injuries of anterior structures, with posterior injuries, such as facet dislocations, which are also treatable.…”

Immediate reduction under general anesthesia and combined anterior and posterior fusion in the treatment of distraction-flexion injury in the lower cervical spine

“…Open reduction can be achieved through an anterior approach alone, a posterior approach alone, or a combined anterior and posterior approach [ 21 ]: the surgical approach is not standardized. Previously, anterior reduction alone was commonly used for facet dislocation patients, because anterior approach rarely causes iatrogenic soft tissue injury as it reaches the injury more directly.…”

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