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Objective The surgical treatment of lower cervical facet dislocation is controversial. Great advancements on reduction techniques for lower cervical facet dislocation have been made in the past decades. However, there is no article reviewing all the reduction techniques yet. The aim is to review the evolution and advancements of the reduction techniques for lower cervical facet dislocation. Methods The application of all reduction techniques for lower cervical facet dislocation, including closed reduction, anterior-only, posterior-only, and combined approach reduction, is reviewed and discussed. Recent advancements on the novel techniques of reduction are also described. The principles of various techniques for reduction of cervical facet dislocation are described in detail. Results All reduction techniques are useful. The anterior-only surgical approach appears to be the most popular approach. Moreover, many novel or modified reduction and fixation methods have been introduced in recent years. Conclusion The selection of surgical approach depends on a combination of factors, including surgeon preference, patient factors, injury morphology, and inherent advantages and disadvantages of any given approach.

Study Design. Biomechanical study Objective. To demonstrate that robotic cervical traction can apply closed cervical traction as effectively as manual weight-and-pulley traction in extension spring and cadaveric models. Summary of Background Data. Closed cervical traction is used to reduce subaxial cervical spine dislocation injuries and to distract the intervertebral space during cervical spine surgery. Weight-and-pulley cervical traction relies on cumbersome and imprecise technology without any safeguard to prevent over-traction or weights being pulled/released inadvertently. Methods. A prototype robotic traction device was designed and manufactured by the authors with real-time tensile force measurement, ± 1-lbs (5 N) force application accuracy, locking/nonbackdriveable linear actuators with actuator position sensing, 200-lbs (900 N) maximum force capability, up to 20° of flexion/extension manipulation, <25-lbs (111 N) device weight, and compatibility with Gardner-Wells tongs or Mayfield head clamp. The device was tested using an extension spring model and an intact fresh cadaver specimen to assess applied and desired force over time and radiographic changes in the cervical spine as traction force increased. The cadaver was tested in manual traction initially and then robotic traction in 10-lbs (50 N) increments up to 80-lbs (355 N) to compare methods. Results. The prototype device met or exceeded all requirements. In extension spring testing, the device reached the prescribed forces of both 25-lbs (111 N) and 80-lbs (355 N) accurately and maintained the desired weight. In cadaveric testing, radiographic outcomes were equivalent between the prototype and manual weight-andpulley traction at 80-lbs (355 N; disk space measurements within ±10% for all levels), and the device reached the desired weight within±1-lbs (5 N) of accuracy at each weight interval. Conclusion. This preliminary work demonstrates that motorized robotic cervical traction can safely and effectively apply controlled traction forces. [ABSTRACT FROM AUTHOR]

Background: Traumatic unilateral lumbosacral facet dislocations are rare injuries. The majority of cases are treated with open reduction and instrumented spinal fusions. Only less commonly can they be managed conservatively. Case Description: A 7-year-old unrestrained passenger was involved in a high-speed motor vehicle accident. X-ray/magnetic resonance/computed tomography imaging documented a unilateral L5-S1 facet dislocation and multiple lumbar/sacral fractures. The patient underwent open reduction and temporary L5-pelvic instrumentation without fusion; the instrumentation was removed 10 weeks later at which point follow-up imaging showed preserved lumbosacral stability. Conclusion: Open reduction with temporary instrumentation without fusion was successfully utilized to treat a unilateral L5-S1 facet dislocation in a 7-year-old child. [ABSTRACT FROM AUTHOR]

A bilateral facet dislocation after anterior cervical fusion with a plate in distraction-flexion injury without significant instability in plain radiography is very rare. This paper reports a case with a confirmed injury status (C6–7 and C7–T1) by magnetic resonance imaging and computed tomography with no visible fractures or displacement on plain radiography. Anterior cervical fusion (C6–T1) was performed with a cage and plate. On the other hand, three days later, C6–7 bilateral facet dislocation developed with severe neck and radiating pain, and posterior decompression and fusion were performed. [ABSTRACT FROM AUTHOR]

The treatment of unilateral CFD in patients without neurologic deficits remains controversial, especially in the choice of the best surgical approach. Our objective is to determine the way spine surgeons from Latin America manage this condition. A survey regarding management and surgical strategies was conducted by the AO Spine Latin American Trauma Study Group considering the treatment of unilateral CFD. All AO Spine Latin American Trauma Study Group members were sent a link to the survey, among whom 285 replied, with 197 respondents answering all the questions. Nonsurgical management was considered by 25% of the surgeons. The majority stated that magnetic resonance imaging is necessary (65%) to treat this type of patient. A posterior approach was preferred by 44%, an anterior approach by 29%, and a combined approach by 25%, while 2.2% did not answer. Traction was not used by the majority of respondents (62%). In the setting of an anterior disk herniation, the majority of surgeons preferred to employ an anterior (45%) or combined (44%) approach versus an isolated posterior approach (only 0.5%). Comparing early versus late cervical trauma, fewer surgeons adopted an isolated anterior approach with the latter (29% vs. 15%). Wide variations exist in the management of unilateral CFD by Latin American surgeons, with early injuries generally treated using either an anterior or posterior approach and treated early but after an MRI, while a combined approach is used more commonly with late injuries. Either an anterior or combined approach is used when disk herniation is present. [ABSTRACT FROM AUTHOR]

Abstract Background Skeletal and soft tissue damage are often associated with unilateral facet dislocations, which undoubtedly lead to instability of the spine and further increase difficulties in cervical reduction. This type of irreducible facet dislocation is usually accompanied with potential catastrophic consequences including neurological deficit and severe disability. Therefore, a consistent and evidence-based treatment plan is imperative. Case presentation The literature regarding the management of traumatic unilateral locked cervical facet dislocations was reviewed. Two patient cases (a 30-year-old Asian man and a 25-year-old Asian woman) who suffered irreducible cervical facet dislocations were presented. These two patients received surgical treatments including posterior reduction by poking facet joints, adjacent spinous process fixation by wire rope banding, anterior plate fixation, and intervertebral fusion after the failure of skull traction and closed reduction. At the postoperative 24-month follow-up, intervertebral fusion was achieved and our patients’ neurological status improved based on the American Spinal Injury Association scale, compared with their preoperative status. Conclusions Unilateral facet joint dislocations of subaxial cervical spine are difficult to reduce when complicated with posterior facet fractures or ligamentous injury. Magnetic resonance imaging can be beneficial for identifying ventral and dorsal compressive lesions, as well as ligamentous or capsule rupture. The combination of posterior reduction and anterior fixation with fusion has advantages in terms of clinical safety, ease of operation, and less iatrogenic damage.

We sought to clarify the safety and unlocking mechanism of the Z-shape elevating-pulling closed reduction (ZR) technique and to analyze the differences in facet contact force and intraspinal pressure during subaxial facet dislocation reduction using the ZR technique and traditional skull traction closed reduction (SR). In 15 human cadaveric skull-neck-thorax specimens, reproducible unilateral and bilateral facet dislocations (UFDs/BFDs) were created at the C5-C6 level and then reduced by applying the ZR and SR techniques, respectively. Tekscan FlexiForce A-201 pressure sensors were used to measure the anterior and posterior intraspinal pressure and injured facet contact force under physiological conditions and before and after reduction. The maximum pressures during the reduction process were recorded. After creation of the facet dislocation, the anterior and posterior intraspinal pressure and facet contact force were significantly increased relative to normal (P < 0.001). The UFDs and BFDs of all specimens were successfully reduced by both ZR and SR, and the intraspinal pressure and facet contact force were significantly reduced compared with before reduction (P < 0.001). Compared with SR, the maximum posterior intraspinal pressure during BFD reduction (P = 0.027) and the maximum facet contact force during UFD reduction (P < 0.001) were lower when ZR was used for closed reduction. Our findings suggest that ZR and SR can both be used to reduce subaxial facet dislocation and decompress the spinal cord. However, the ZR technique appears to safer and more effective than the SR technique for closed reduction of subaxial facet dislocations. [ABSTRACT FROM AUTHOR]

Objective: The surgical treatment of lower cervical facet dislocation is controversial. The objective of this study was to compare the surgical trauma and clinical results of a novel anterior-only approach and with those of the conventional posterior-anterior approach to obtain an optimal method to treat lower cervical facet dislocation.Methods: From January 2012 to December 2017, 93 patients with lower cervical facet dislocations were enrolled in the study and divided into two groups as follows: 63 conventional patients who enrolled between January 2014 and December 2017 were included in the anterior-only approach group, and 30 conventional patients who enrolled between January 2012 and December 2013 were included in the posterior-anterior approach group. For the anterior-only approach group, two reduction techniques, including Caspar pins kyphotic paramedian distraction and anterior facetectomy, were used in sequence if the former technique failed. The parameters were as follows: the operation time, the intraoperative blood loss, the number of fixed segments, the fusion rate, and the improvement in the ASIA grade and JOA score.Results: All patients in the anterior-only approach group were successfully reduced by the two techniques. The mean operation time in the posterior-anterior approach group (274.0 ± 114.7 min) was significantly longer than that in the anterior-only approach group (88.6 ± 35.0 min) (p = 0.000). The mean blood loss during the surgery and the number of fixed segments in the posterior-anterior approach group (275.0 ± 183.2 ml; 1.4 ± 0.7, respectively) were significantly greater than those in the anterior-only approach group (92.5 ± 84.0 ml, p = 0.000; 1.2 ± 0.5, p = 0.030, respectively). A 100% fusion rate was observed in both groups after 12-month follow-up. There were no significant differences between the two groups regarding the improvement in the ASIA grade (p = 0.900) or JOA score (p = 0.717).Conclusions: Compared with the conventional posterior-anterior approach, the novel anterior-only approach with two reduction techniques, including Caspar pins kyphotic paramedian distraction and anterior facetectomy, achieved a 100% reduction success rate and induced less surgical trauma, indicating that this method can be recommended as an alternative for lower cervical facet dislocation. These slides can be retrieved under Electronic Supplementary Material. [ABSTRACT FROM AUTHOR]

Background Facet dislocations, or jumped facets, are part of a spectrum of flexion-distraction spine injuries. Bilateral and unilateral facet dislocations are commonly seen in the cervical spine. Traumatic jumped facets in the lumbar spine are rare injuries, and most involve the lumbosacral junction. Lumbar facet subluxations occur commonly in young patients owing to flexion-distraction forces on the lumbar spine at the time of injury combined with ligamentous laxity that exists in young patients. Case Description A 24-year-old man presented with a unilateral right facet dislocation at L3-4 with anterolisthesis and canal stenosis after a motor vehicle accident. Conclusions Following anatomic reduction, unilateral jumped facets can be effectively treated with instrumented stabilization. This report provides evidence for the durability of short segment arthrodesis in select cases of a rare lumbar facet subluxation. Highlights • Reports of unilateral lumbar facet dislocations are rare; most reported dislocations involve the lumbosacral junction. • We describe a 24-year-old man with unilateral right facet dislocation at L3-4 with listhesis and canal stenosis. • There is 1 other case of L3-4 facet dislocation in the literature. • We provide a treatment strategy for midlumbar facet dislocations and show good outcome with short segment arthrodesis. [ABSTRACT FROM AUTHOR]

Objective: The surgical treatment of lower cervical facet dislocation is controversial. Great advancements on reduction techniques for lower cervical facet dislocation have been made in the past decades. However, there is no article reviewing all the reduction techniques yet. The aim is to review the evolution and advancements of the reduction techniques for lower cervical facet dislocation., Methods: The application of all reduction techniques for lower cervical facet dislocation, including closed reduction, anterior-only, posterior-only, and combined approach reduction, is reviewed and discussed. Recent advancements on the novel techniques of reduction are also described. The principles of various techniques for reduction of cervical facet dislocation are described in detail., Results: All reduction techniques are useful. The anterior-only surgical approach appears to be the most popular approach. Moreover, many novel or modified reduction and fixation methods have been introduced in recent years., Conclusion: The selection of surgical approach depends on a combination of factors, including surgeon preference, patient factors, injury morphology, and inherent advantages and disadvantages of any given approach.

Objective: The cervical vertebra are the most mobile segments of the vertebral spine. Since there are few supportive structures in our bodies, this part is more susceptible to traumatic injury. One of the most common injuries is facet fracture and dislocation that may be uni/bilateral. Primary treatment is a closed reduction with skull traction. In some cases the facets are locked and it is impossible to treat even with maximal closed traction. Open reduction by surgical intervention is a suitable way for treatment. Methods: This retrospective study was done on patients with trauma of vertebral spine referred to emergency center during three years. This survey was done on 274 patients with trauma of cervical spine and 19 patients with locked facet syndrome. Findings: From 19 patients, 12 were male and 7 were female. Falling from a high place was the most common cause of injury. It happened more in second and third decade of their life. The most common manifestation was neck pain. 12 patients had no neurological deficit, 4 patients had incomplete neurological deficit and 3 had completed neurological deficit. Conclusion: Different methods such as interspinous wiring, interfacet wiring and lateral mass plating were used for treatment.

Study Design. Retrospective case series. Objective. To discuss the clinical efficacy of anterior cervical surgery of decompression, reduction, stabilization, and fusion in treating subaxial cervical facet dislocation without spinal cord injury or with mild spinal cord injury monitored by spinal cord evoked potential. Summary of Background Data. The optimal treatment of lower cervical facet dislocation has been controversial. Because of the risk of iatrogenic damage of neurological function, it is challenging for surgeons to manage the lower cervical facet dislocation without or with mild spinal cord injury. To avoid the risks, more secure strategy need to be designed. Methods, A retrospective study was performed on 17 cases of subaxial cervical facet dislocation without spinal cord injury or with mild spinal cord injury treated by anterior cervical surgery under spinal cord evoked potential monitor from January 2008 to June 2012. There were 12 males, 5 females, with a mean age of 40.1 years (from 21 to 73 yr). Dislocation sites: 1 in C3-C4, 2 in C4-C5, 6 in C5-C6, 8 in C6-C7; 10 cases with unilateral cervical facet dislocation, 7 cases with bilateral dislocation. Thirteen patients were preoperatively classified as grade D and 4 as E according to Frankel standard. All patients were followed up for average of 16 months. Results. All operations were completed successfully. Postoperative radiographs showed that the sequence and curvature of the cervical spine were well recovered. And, evidence of intervertebral fusion was observed at 3 months in all cases. No redislocation or symptoms of spinal cord injury occurred. Thirteen cases with mild spinal cord injury recovered at 1 month after operation. Conclusion. Anterior cervical surgery of decompression, reduction, stabilization, and fusion monitored by spinal cord evoked potential is an effective and safe method for treatment of subaxial cervical facet dislocation without or with mild spinal cord injury. [ABSTRACT FROM AUTHOR]

Abstract: Flexion-distraction injuries are among the most common mechanisms for subaxial cervical trauma. There is a high risk of neurological compromise with these injuries. The history and examination of injuries are essential components that should be performed on all patients. Imaging should include plain radiographs, computed tomography, and magnetic resonance imaging for diagnosis and treatment planning. Early closed reduction may be performed on awake cooperative patients. Anterior or posterior stabilization may be used, although anterior fixation alone has higher failure rates in the setting of a concurrent vertebral body fracture. Although functional and neurological status can improve, particularly after operative intervention, flexion-distraction injuries affect patient''s health-related quality of life and outcome long after the injury. Prompt and accurate diagnosis of the osseous, ligamentous, disk, and neurologic components of the injury will provide the best patient outcome. [Copyright &y& Elsevier]

The article presents a multicenter prospective cohort study determining the difference between long-term clinical outcomes and baseline characteristics in patients with cervical spinal cord injury (SCI) with and without facet dislocation (FD). Patients were assigned to FD and non-FD groups and primary and secondary outcomes were measured. The results showed that cervical SCI patients with FD appear to have severe initial injury and less chances of motor recovery as compared to those without FD.

Objective: For patients with cervical and thoracolumbar AO Spine type C injuries, the authors sought to 1) identify whether preoperative vertebral column translation is predictive of a complete spinal cord injury (SCI) and 2) identify whether preoperative or postoperative vertebral column translation is predictive of neurological improvement after surgical decompression., Methods: All patients who underwent operative treatment for cervical and thoracolumbar AO Spine type C injuries at the authors' institution between 2006 and 2021 were identified. CT and MRI were utilized to measure vertebral column translation in millimeters prior to and after surgery. A receiver operating characteristic (ROC) curve was generated to predict the probability of sustaining a complete SCI on the basis of the amount of preoperative vertebral column translation. ROC curves were then used to predict the probability of neurological recovery on the basis of preoperative and postoperative vertebral column translation., Results: ROC analysis of 67 patients identified 6.10 mm (area under the curve [AUC] 0.77, 95% CI 0.650-0.892) of preoperative vertebral column translation as predictive of complete SCI. Additionally, ROC curve analysis found that 10.4 mm (AUC 0.654, 95% CI 0.421-0.887) of preoperative vertebral column translation was strongly predictive of no postoperative neurological improvement. Residual postoperative vertebral column translation after fracture reduction and instrumentation had no predictive value on neurological recovery (AUC 0.408, 95% CI 0.195-0.622)., Conclusions: For patients with cervical and thoracolumbar AO Spine type C injuries, the amount of preoperative vertebral column translation is highly predictive of complete SCI and the likelihood of postoperative neurological recovery.

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 6e9) and the mean time from injury to surgery 9 days (range 1e50 days). Mean hospital stay 28 days (range 5e100 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. [ABSTRACT FROM AUTHOR]

Study Design: Retrospective case series. Purpose: The objective of our study was to determine the change in management brought about by magnetic resonance imaging (MRI) of the cervical spine in alert and awake patients with facet dislocation and spinal cord injury presenting within 4 hours after injury. Overview of Literature: Spinal cord injury is a common clinical entity. The role of MRI is well established in evaluating spinal trauma. However , the time at which MRI should be used is still controversial. Methods: Retrospective data from 2002-2010 was evaluated. All of the alert and awake patients with spinal cord injury , based on clinical examination with facet dislocation diagnosed on lateral cervical spine X-rays , were included. A questionnaire was also conducted , the data of which consisted of demographic details including age and sex , the mechanism of injury , clinical examination , X-ray findings , MRI findings , whether or not surgery was performed and the time elapsed since injury. Data was analyzed using SPSS ver. 17.0. Continuous variables such as age were expressed in terms of mean ± standard deviation. Categorical variables such as change in management , X-ray/MRI findings and neurological motor level were assessed in terms of percentage. Results: Fifty patients participated in our study. All these patients had spinal cord injury with defined motor levels. The mean age was 35.5 ± 8.95 years (range , 20 to 52 years). Fifty percent showed a motor level at C6 level. None of the patients required any change in management based on the MRI. Conclusions: MRI of the spine in awake patients within 4 hours after injury does not change the management of patients. However ,we can hypothesize that such patients can proceed to traction without waiting for the MRI. [ABSTRACT FROM AUTHOR]

Purpose: 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. Methods: 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. Results: 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. Conclusions: 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. [ABSTRACT FROM AUTHOR]

The article discusses a study that assessed the inter-observer reliability of radiographic measurements for subaxial cervical spine trauma. The reliability of measurements made on computed tomography (CT) versus those made using plain radiographs is compared. Findings show that radiographic measurements for subaxial cervical spine trauma are unreliable, despite a consensus regarding their importance in directing treatment.

Background: Traumatic unilateral facet dislocation without fracture is an uncommon injury of the lumbosacral junction. We describe a case of a unilateral perched L5-S1 facet causing axial back pain and radiculopathy provoked by motion. Case Description: The patient underwent reduction with complete facetectomy followed by internal fixation at L5-S1, facilitating decompression of the S1 nerve root. Postoperatively, the patient reported improvement in her pain. Conclusions: This injury can be recognized using subtle clues, such as transverse process fractures and/or widened posterior elements. Despite its rarity, when identified, this injury can be characterized using the new TLICS system for thoracolumbar fractures and should be managed accordingly. [ABSTRACT FROM AUTHOR]

Abstract: Unilateral facet dislocation of the lumbosacral junction is considered the mildest form of traumatic lumbosacral dislocation. This is an extremely rare injury that can be a diagnostic challenge in an emergency setting, where radiography is often inadequate. CT or MR may be useful for early diagnosis and treatment. Imaging findings in a new case are presented and the usefulness of different imaging methods is reviewed. [Copyright &y& Elsevier]

Background. Bilateral cervical locked facets is a severe traumatic lesion, most frequently resulting in tetraplegia. The common treatment strategy has been an attempt of awake, closed reduction, adding general anesthesia, muscle relaxation and manual traction in difficult cases. In cases of failed closed reduction, open reduction has most commonly been performed by a posterior approach. Patients in the current series have been managed by immediate open anterior reduction and circumferential fixation/fusion. The technique is described and its potential advantages are discussed.Method. Five consecutive patients with traumatic bilateral cervical locked facets are reported. The injury level was C4/5 in one and C5/6 in four patients. Four patients had initial tetraplegia, one patient was neurogically intact. All patients underwent immediate open anterior reduction by interbody distraction and gentle manual traction, followed by circumferential fixation/fusion. Mean follow-up was 15 months.Findings. Immediate anterior open reduction was rapidly and reliably achieved in all five patients. No surgical complication occurred. All patients showed fusion at the three-month follow-up. All four tetraplegic patients regained at least one functional root level, but remained tetraplegic.Conclusion. Immediate open anterior reduction of bilateral cervical locked facets and combined antero-posterior fixation/fusion was safe and reliable. This treatment strategy avoids time loss and patient discomfort from attempted closed reduction by traction, obviates the need for external immobilization, and results in an excellent fusion rate. [ABSTRACT FROM AUTHOR]

Background Context: Traumatic cervical facet dislocation accounts for a disproportionate rate of neurologic disability. The relative importance of patient and management variables, including the timing of spinal reduction, in ultimate neurologic outcome has not been well defined. Purpose: To analyze data from a cohort of patients sustaining traumatic cervical facet dislocation to determine the relative importance of several patient and management variables in neurologic recovery after injury. Study Design/setting: A retrospective study was conducted at a major referral center for spinal-cord-injured patients. Patient Sample: Forty-five patients sustaining traumatic cervical facet dislocation. Outcome Measures: Using improvement in American Spinal Injury Association (ASIA) motor score as the primary outcome measure, patient data were used to construct a statistical model allowing the analysis of several clinically relevant variables. Methods: The records of patients sustaining a traumatic cervical facet dislocation over a 5-year period were reviewed. Clinical data were collected for all patients with adequate follow-up. The data were used to construct a statistical model designed to analyze the contribution of the variables age, gender, time to reduction of the spine and initial motor score to neurologic improvement (the outcome measure). In addition, the effect of variable interaction was studied. Results: Most patients demonstrated neurologic improvement over the course of follow-up after cervical facet dislocation. For this data set, the variables age and initial motor score were significantly associated with neurologic improvement. However, time to reduction of the spine did not demonstrate a significant independent relationship to neurologic outcome. No significant interaction was found between patient age or gender and the time to reduction with regard to predicting neurologic recovery. Conclusion: The present study uses a statistical model to determine the relative importance of clinically relevant variables for a population of patients after traumatic cervical facet dislocation. This model confirms the clinical impression that younger patients with lesser degrees of neurologic injury tend to achieve the best neurologic recovery after a traumatic facet dislocation. Although a strong benefit from earlier spinal column reduction did not emerge from the present data set, additional study is needed to define those patients who would benefit from immediate reduction of the spinal column. [ABSTRACT FROM AUTHOR]

We present a case of traumatic L4-5 bilateral facet dislocation, without neurological deficit, in a 32-year-old female patient, as an unusual seatbelt injury caused by positioning the shoulder harness improperly under her armpit. Open reduction, posterior interbody fusion, and posterior segmental instrumentation were carried out. The aim of this report is to describe this rarely encountered condition and speculate regarding automotive shoulder harness misuse as a potential cause of bilateral locked facet at L4-5, and to emphasize the importance of multidirectional X-ray on first examination. The unusual L4-5 level facet interlocking was attributed to misuse of the automobile shoulder harness. We propose the importance of recognizing this injury and following up on such clues as transverse process fractures and/or widened posterior elements. [ABSTRACT FROM AUTHOR]