Management of Bilateral Locked Facets of the Cervical Spine

Abstract

The management of 15 cases of bilateral locked facets of the cervical spine is reviewed. The C-6, C-7 interspace was the most common interspace involved. There were 4 females and 11 males who were 16 to 63 years old (average, 26 years). Thirteen patients had a complete spinal cord lesion with loss of function below the level of the locked facets. Two had intact dorsal column function. One patient had an ascending spinal cord deficit, which did not change after open reduction. The remainder had no change in spinal cord function after reduction. However, after reduction, 1 patient had a transient root deficit and 2 patients improved in the function of the involved roots. Closed reduction was accomplished by (a) skeletal traction and weight application, (b) manual reduction under sedatives, or (c) manual reduction under general anesthesia. Five patients required open reduction. The failure of closed reduction was attributed to accompanying fractures of one of the facets in 2 cases, increasing neurological deficits during traction in 2 cases, and associated higher cervical fractures in 1 case. Internal stabilization with wire and bone or external stabilization with a halo vest or a brace was used. Twelve patients were followed for 1 1/2 to 7 years (average, 2.7 years). Stabilization after reduction was successful irrespective of the methods used. The various methods of reduction and stabilization are reviewed and discussed.

Spinal Facet Joint Biomechanics and Mechanotransduction in Normal, Injury and Degenerative Conditions

“…Also, the increase in laxity was associated with some ligament tearing, supporting both the hypothesis that the ligament sustained damage and exhibited altered mechanical properties [206]. Taken with reports of instability following facet dislocation [193,201,207], these findings imply that there may be a continuum between the degree of instability and trauma to the facet, with greater instability for more severe facet trauma, including dislocation and the more-extreme fracture.…”

“…Although unilateral facet injuries might not induce any neurological disorders [192], these injuries can cause severe chronic pain without local pathology [193]. Radiculopathy, myelopathy, spinal cord injury, and neck pain have all been reported in conjunction with facet injuries [195,207]; facet injuries have also been linked to neurologic deficit, vertebral artery injury, and avascular necrosis of the articular pillar [217][218][219][220]. The array of neurologic disorder and syndromes associated with facet injury show that the mechanical function of the facet joints is essential not only for spinal motion but also for the protection of neural structures important to the proper function of the nervous system.…”

Morphometric analyses of the cervical superior facets and implications for facet dislocation

“…The most common levels were C5-6 and C6-7, having ten each (total 71.4%). Bilateral facet dislocation is associated with significant soft tissue injury, including rupture of the posterior ligamentous complex, facet joint capsules, annulus fibrosus, and usually the anterior and posterior longitudinal ligaments [1,2,4,16] with both facets remaining intact but dislocated. The inferior facet of the upper vertebra slides over the tip of the superior facet of the lower vertebra.…”

The Management of Bilateral Interfacetal Dislocation with Anterior Fixation in Cervical Spine : Comparison with Combined Antero-Posterior Fixation

“…Methods described to treat these patients have included prolonged cervical traction, immobilization with a Halo thoracic brace, posterior cervical wiring or lateral mass plates, anterior cervical fixation with cervical screw-plate and combined antero-posterior stabilization 1,4,8,10,[20][21][22][23] . Traditionally, the disruption of the posterior ligaments in bilateral cervical interfacetal dislocation has lead one to combined antero-posterior fixation with immobilization using a hard collar or Halo thoracic brace.…”