Spine conference: facet injuries

1. Facet Injuries in the
Cervical Spine
Spine Conference
August 24, 2021

2. o woman cc neck pain L UE pain HPI: MVA belted driver swerved to
d another car and R front panel struck a wall head on causing a
lash injury; no airbag; cannot sit up at all, stays supine and at 30 up
re pain in neck. Pain neck L trap, lat arm rad forearm with numbness
F, MF, RF, LF; no R sx; PMH: dep/anx, bariatric surg, HTN SH:
mployed smoker LHD PE: 5'7" 313 lb BMI 49 left elb flex/ext 4/5 motor

3. 3% of all blunt trauma victims suffer a cervical fracture
How do you describe a car accident?

5. CT is the choice initial image for cervical trauma. 98% sensitive

6. Checklist for CT
cervical spine
evaluation
Raniga SB, Menon V, Al
Muzahmi KS, Butt S.
MDCT of acute subaxial
cervical
spine trauma: a
mechanism-based
approach. Insights
Imaging
2014;5(3):321–38.
https://doi.org/10.1007/s
13244-014-0311-y.

20. unilateral facet fx/dislocation

22. Usually C5c6 or c6c7
B facet dislocations have 85% neuro injury
“jumped” or “locked” facets

24. In general, dislocations need reduction to
avoid ischemia to tissues and
neurovascular deterioration

25. Closed reduction can be safely performed in an awake patient that
Can be examined; 10 lb and increase 10lb more every 5-20 min

26. A disc fragment
posterior to the
cephalad vertebral
C4

27. Locked facet open reduction
Posterior fixation may note be
possible due to fracture

28. 21 days out
After reduction the ligamentum flavum can compress the spinal cord if torn by the
Injury and then fold inwards during reduction

30. Back to our case….

31. C6
MRI evaluates DLC: discoligamentous complex

36. Mechanism of injury

38. White and Punjabe classification 1990

39. 0-3 closed Rx
5 and up: surgery
DLC: discoligamentous complex

40. AOSpine subaxial classification system

41. Is there an injury?
Is it stable?

43. 41 year old woman
1. Severe neck L trap pain with
numbness fingers
2. only tolerable position is
completely supine; unbraceable
3. BMI 49
4. C6C7 nondisplaced facet fx
with concomitant small disc
herniation

44. How do you confirm the level intraoperatively?

52. Thanks!