Sub-Axial Cervical Facet Dislocation: A Review of Current Concepts

Abstract

Cervical facet dislocation is a serious injury that carries risks of short- and long-term morbidity. The optimal management of these injuries remains controversial with the ongoing debate regarding indications and requirements for closed reduction, timing, type of surgical approach and method of fixation. This review gives an update on the relevant anatomy, classification systems for sub-axial cervical facet dislocation and an overview of the current concepts regarding their management, including surgical approaches and the choice of implants.

Keywords: cervical fusion; cervical trauma; decision making; emergency management; facet dislocation; spine injury; subaxial; surgical management.

Figure 1. Illustration demonstrating flexion distraction injury as the usual mechanism for facet dislocation

Figure 2. Sagittal cuts of the cervical spine CT scan demonstrating unilateral facet dislocation at the C6-C7 level

Case courtesy of Associate Prof. Frank Gaillard, https://radiopaedia.org/, rID: 35609

Figure 3. T2 sagittal cuts of an MRI (the same case as in Figure 2) demonstrating a complete rupture of the ligamentum flavum at C6-7 with related short-segment posterior epidural hematoma, and disrupted ALL at C7 with pre-vertebral hematoma, also showing the extent of damage to the intervertebral disc

ALL, anterior longitudinal ligament Case courtesy of Dr Andrew Dixon, https://radiopaedia.org/, rID: 31837

Figure 4. C5-6 unilateral facet joint dislocation. Lateral radiographs of the cervical spine demonstrating (A) unilateral facet joint dislocation at the C5-C6 level and (B) two years after operation (ACDF) showing well reduction and fixation state

ACDF, anterior cervical decompression and fusion Image courtesy: ResearchGate. Available from https://www.researchgate.net/figure/C5-6-unilateral-facet-joint-dislocation-Lateral-radiographs-A-of-the-cervical-spine_fig14_274058208 (accessed November 25, 2019), via license: Creative Commons Attribution-NonCommercial 3.0 Unported.