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Case Reports
. 2014 Spring;14(1):108-11.

Neurologically intact patient following bilateral facet dislocation: case report and review of literature

Vikram Chakravarthy  1 , Jeffrey P Mullin  2 , E Emily Abbott  2 , James Anderson  3 , Edward C Benzel  2
Affiliations
Case Reports

Neurologically intact patient following bilateral facet dislocation: case report and review of literature

Vikram Chakravarthy et al. Ochsner J. 2014 Spring.

Abstract

Background: Complete spinal cord lesions and quadriplegia occur in 50%-84% of patients with bilateral facet dislocation. We present a patient who suffered both bilateral facet dislocation and bilateral pedicle fractures while remaining neurologically intact. Based on this case and our literature review, we hypothesize that bilateral facet dislocations without neurological deficits are accompanied by significant associated fractures that facilitate the maintenance of cervical spine canal patency.

Case report: After a fall down a flight of stairs, an 86-year-old woman presented to the hospital complaining of neck pain. She denied numbness and weakness of her extremities. On physical examination she was neurologically intact without focal sensory or motor deficits and with normal reflexes throughout. Computed tomography (CT) of her neck demonstrated bilateral C5-C6 facet dislocation with locking of the C6 superior articular process dorsal to the C5 inferior articular process, as well as corresponding bilateral C6 pedicle fractures. Additional acute fractures were identified on the thoracic CT. Magnetic resonance imaging demonstrated no spinal cord compression, edema, or hemorrhage. The patient had a C6-C7 anterior cervical discectomy and allograft fusion and a C5-T1 anterior cervical plate with screw fixation.

Conclusion: Because bilateral facet dislocations without neurological deficits are rare, the most appropriate surgical intervention is not evident. We believe the best choice as a first step is an anterior cervical discectomy and allograft fusion with plating.

Keywords: Cervical vertebrae; decompression–surgical; spinal canal; spinal cord compression; traction.

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Conflict of interest statement

The authors have no financial or proprietary interest in the subject matter of this article.

Figures

Figure 1.
Figure 1.
Initial computed tomography scan. Paramedian cuts of sagittal cervical spine demonstrating C5-C6 facet dislocation and C6 pedicle fracture.
Figure 2.
Figure 2.
Initial computed tomography scan. Midline cuts of sagittal cervical spine demonstrating apparent canal stenosis due to C5-C6 facet dislocation.
Figure 3.
Figure 3.
Initial computed tomography 3-dimensional reconstruction demonstrating C5-C6 facet dislocation from the anterior oblique view.
Figure 4.
Figure 4.
Postoperative radiographs showing (A) lateral swimmer's view and (B) anteroposterior view after C5-T1 anterior cervical discectomy and fusion.
See this image and copyright information in PMC

References

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