Cervical spine injury with bilateral facet dislocation, surgical treatment and outcome analysis: A prospective study of 19 cases

Abstract

Background

Bilateral cervical facet dislocations present with severe neurological deficits and an unstable spine. Aim of this study was to evaluate the surgical outcome in cervical spine injury with bilateral facet dislocations.

Methods

There were 19 cases of cervical bilateral facet dislocations from Jan 2010 to March 2011. The SLIC scoring was used for surgical decision. Anterior approach with decompression and fixation was done. Postoperative CT/neurological outcome assessment postoperatively/follow up visits.

Results

Mean age was 38 years (range 11–60 years), (M:F 18:1). Fall from height noted in 80% (n = 15), road traffic accident in 10% (n = 2) and two were domestic violence related. High velocity injury seen in 16% (n = 3) and low velocity injury in 84% (n = 16). ASIA A noted in majority, one patient had no neurological deficit (ASIA E). C5/6 and C 6/7 were most common injured segments (80%). Disc compression noted in 58% (n = 11) patients. Mean SLIC score was 8 (range 6–9) and the mean time from injury to surgery 9 days (range 1–50 days). Mean hospital stay 28 days (range 5–100 days). Realignment and reduction of facets achieved in 84% (n = 16) patients. Improvement of ASIA impairment score by >1 score noted in 37% (7/19) patients, mortality was 37% (7/19). Preoperative neurological status was the only significant determinant of neurological outcome (p = 0.009).

Conclusion

Bilateral facet dislocations are mostly low velocity injuries related and have poor neurological outcome. Anterior only approach with peroperative reduction of dislocated facets is recommended to stabilize the spine.

Keywords

Facet dislocation - Spinal cord injury - Anterior approach

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