Unilateral Cervical Facet Fracture-Dislocation

Abstract

While relatively rare in the young child, the incidence of subaxial cervical fractures and dislocations in children over 8 years of age approaches adult rates. Horizontally oriented facet joints and the lack of uncovertebral joints predispose the immature spine to increased motion in the sagittal and coronal planes, respectively. Unilateral facet dislocations result from combined flexion-distraction and rotatory forces which typically occur after motor vehicle accidents or falls from heights. The presentation of these injuries can be subtle as children may complain only of neck pain. A careful physical examination is required to identify pretreatment neurologic deficits. Diagnosis is aided by advanced imaging studies, with Computed Tomography (CT) scans clearly delineating the bony injury while assisting in surgical planning. A pretreatment Magnetic Resonance Imaging (MRI) is recommended to evaluate for both disk herniation and injuries to the posterior ligamentous complex. Unilateral facet dislocations are characterized by a degree of rotational instability, with the axis of rotation centered around the intact contralateral facet. Persistent instability and worse long-term outcomes have been demonstrated with nonoperative treatment in the adult population. While closed reduction and prolonged external immobilization with a halo vest is possible, rigid internal surgical stabilization is preferred in the pediatric population. Solid arthrodesis is frequently attained and, in the absence of spinal cord injury, long-term outcomes are generally good.