Fracture and contralateral dislocation of the twin facet joints of the lower cervical spine
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The combination of a facet fracture and a contralateral facet dislocation at the same intervertebral level of the cervical spine (a fracture and contralateral dislocation of the twin facet joints) has not been described in detail. The aims of this study are to report a series of 11 patients with this injury, to clarify the clinical features and to discuss its pathomechanism.
Among 251 patients with lower cervical spine fractures and/or dislocations surgically treated, 11 (9 males and 2 females, averaged age, 52 years) had this kind of injury. Medical charts and medical images were reviewed retrospectively.
Injury levels were C4-5, C5-6 and C6-7 in 1, 4 and 6 patients, respectively. A fracture was found at the superior facet in 6, and at the inferior facet in 5. The anterior displacement of the vertebral body ranged from 7 to 19 mm. The unilateral horizontal facet appearance on an anteroposterior radiograph and the triple image on a CT composed of a separated fracture fragment, the base of the fractured facet, and the neighboring non-fractured facet were characteristic. All patients had neurological deficits from Frankel A to D, and were surgically treated by posterior fusion using wire or cable, or combined anterior and posterior spinal fusion.
The fracture and contralateral dislocation of the twin facet joints can cause severe neurological deficits because of its gross anterior displacement. Its plausible pathomechanism is extension force exerted to the cervical spine when it is maximally bent laterally.
KeywordsCervical spine Facet fracture Facet dislocation Distractive flexion injury Compressive extension injury Neurological deficits
Conflict of interest
No financial and no nonfinancial conflict of interest.
- 13.Lee C, Kim KS, Roger LF (1982) Triangular cervical vertebral body fractures: diagnostic significance. Am J Roentgenol 138:1123–1132Google Scholar
- 16.Orthpaedic Trauma Association. Fracture and dislocation compedium (1996) J Orthop Trauma 10 (Suppl 1):1–154Google Scholar
- 17.Patel AA, Dalley A, Brodke DS, Daubs M, Anderson PA, Hurlbert RJ, Vaccaro AR, Spine Trauma Study Group (2008) Subaxial cervical spine trauma classification: the Subaxial Injury Classification system and case examples. Neurosurg Focus 25:E8Google Scholar
- 19.Rogers WA (1942) Treatment of fracture-dislocation of the cervical spine. J Bone Joint Surg 24:245–258Google Scholar
- 22.Shanmuganathan K, Mirvis SE, Levine AM (1994) Rotational injury of cervical facets: CT analysis of fracture patterns with implications for management and outcome. Am J Roentgenol 163:1165–1169Google Scholar
- 24.Tani S, Ishii Y, Kokubun S (1994) Clinical feature and treatment of compressive extension injuries of the lower cervical spine. Seikeigeka (Orthop Surg) 45:533–540 (in Japanese)Google Scholar
- 26.Whitley JF, Forsyth FH (1960) The classification of the cervical spine injuries. Am J Roentgenol 83:633–644Google Scholar
- 27.White A, Panjabi M (1990) Kinetics of the spine. In: Clinical Biomechanics of the Spine, 2nd edn. JB Lippincott, Philadelphia, pp 85–126Google Scholar