Cervical facet dislocations in the adolescent population: a report of 21 cases at a Level 1 trauma center from 2004 to 2014

• Published in: European spine journal Vol. 26; no. 4; pp. 1266 - 1271
• Main Authors: Anissipour, Alireza K., Agel, Julie, Bellabarba, Carlo, Bransford, Richard J.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-04-2017; Springer Nature B.V
• Subjects: Adolescent; Cervical Vertebrae - injuries; Cervical Vertebrae - surgery; Child; Female; Humans; Intervertebral Disc Displacement - epidemiology; Intervertebral Disc Displacement - surgery; Joint Dislocations - epidemiology; Joint Dislocations - surgery; Male; Medicine; Medicine & Public Health; Neurosurgery; Original Article; Recovery of Function; Retrospective Studies; Spinal Fractures - epidemiology; Spinal Fractures - surgery; Spinal Fusion; Surgical Orthopedics; Trauma Centers; United States - epidemiology; Zygapophyseal Joint - injuries; Zygapophyseal Joint - surgery; Pediatric spine trauma; Cervical trauma; Spinal cord injury; Cervical facet dislocation
• ISSN: 0940-6719; 1432-0932
• DOI: 10.1007/s00586-017-5003-0

Purpose
The purpose of this study was to present a series of adolescent patients with cervical facet dislocations to identify the mechanism of injury, severity of neurological injury and rate of neurological recovery.
Methods
Between 2004 and 2014, a retrospective review at a level I trauma center identified patients with unilateral or bilateral dislocated facet(s). Demographic data, initial neurological exams, surgical data, radiographic findings, and follow-up records were reviewed.
Results
Of the 21 adolescent facet dislocations, 7 were unilateral and 14 bilateral. Mean age was 14.9 years; (range 12–17). Male:female ratio was 15:6. All patients presented as a result of a high-energy injury. C6–7 was the most common level of dislocation. 1 of 18 (5.5%) patients had a cervical disc herniation on MRI. Nine (43%) patients had an associated facet fracture (8 unilateral, 1 bilateral). None of the 12 patients who presented as a complete spinal cord injury (SCI) (AISA A) had any neurological recovery. Only one of the three patients who presented as an incomplete SCI (ASIA B, C, D) had an ASIA grade improvement at final follow-up. Six patients who presented were neurologically intact (ASIA E).
Conclusion
Over half of children with this injury in our study had a complete SCI with no recovery. We believe that the adolescent spine is more resilient to injury, thus requiring a high-energy injury to cause a dislocation, but resulting in a high rate of SCI with a low rate of neurological recovery, and a low rate of cervical disc herniation.