- Juha Hernesniemi International Neurosurgery Center, Henan Provincial People´s Hospital, Henan University, Zhengzhou 450003, China
- Vancouver Spinal Surgery Institute and Department of Surgery, Division of Neurosurgery, Vancouver, British Columbia, Canada
- Department of Neuroradiology, Vancouver General Hospital, Vancouver, British Columbia, Canada
DOI:10.25259/SNI-95-2019Copyright: © 2019 Surgical Neurology International This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
How to cite this article: Ajmal Zemmar, Hanbing Zhou, Vincent Ye, Jason Shewchuk, David Volders, Nicolas Dea. Bilateral cervical facet dislocations at two adjacent levels: A case report. 26-Mar-2019;10:48
How to cite this URL: Ajmal Zemmar, Hanbing Zhou, Vincent Ye, Jason Shewchuk, David Volders, Nicolas Dea. Bilateral cervical facet dislocations at two adjacent levels: A case report. 26-Mar-2019;10:48. Available from: https://surgicalneurologyint.com/surgicalint-articles/9236/
Background: Cervical facet dislocations are rare in patients sustaining traumatic subaxial injuries. They occur due to hyperflexion-distraction and can occur unilaterally or bilaterally resulting in significant spinal instability. Bilateral facet dislocations at one level are less common than unilateral dislocations, while bilateral facet dislocations at adjacent spinal levels have only been reported twice in literature.
Case Description: A 31-year-old male presented with bilateral facet dislocations at two adjacent cervical levels (C6/C7 and C7/T1) following a fall from 40 to 50 feet. The patient had undergone a C6/C7 disk arthroplasty a few weeks before the traumatic event.
Conclusion: Here, we present the unique case of cervical bilateral jumped facets occurring at two adjacent levels (i.e., C6–C7 and C7–T1). Notably, the antecedent cervical C6–C7 arthroplasty likely contributed to the altered load distribution, leading to this unusual instance of bilateral adjacent level facet dislocations. In such cases, surgical reduction and fixation may prove technically challenging warranting, therefore, careful preoperative planning.
Keywords: Cervical, disk arthroplasty, double-level bilateral facet dislocation, spinal trauma
Cervical facet dislocations occur in 5–10% of cervical spinal trauma cases due to hyperflexion-distraction injuries. Bilateral adjacent-level dislocations are very rare and have thus far only been reported twice in literature.[
A 31-year-old male fell from a balcony approximately 40–50 feet height. On admission with a GCS score of 5, he was unable to move his extremities and had no rectal tone. A computed tomography (CT) scan of the cervical spine demonstrated bilateral locked facets at C6/C7 [
Locked facets are demonstrated at the C6/7 level. (a-d) On the right. (a and c) And left side. (b and d). and C7/T1 level. (f-i) On the right side. (f and h) And the left side. (g and i). Grade 1 anterolisthesis of C7 on T1 and a disc arthroplasty at the C6/7 level are appreciated. (e). Disruption of the ligamentum flavum and cord signal change is seen from C5 to T2 (j).
The magnetic resonance imaging (MRI) scan demonstrated injury to the C6/C7 and C7/T1 ligaments: the ligamentum flavum and interspinous, anterior, and posterior longitudinal ligaments [
The patient underwent emergent posterior spinal decompression with fusion from C4 to T2. The pedicles of C7 were fractured bilaterally and several attempts to achieve reduction were unsuccessful. The posterior elements of C7 were considerably loose due to the bilateral pedicle fractures. Ultimately, removal of the superior facets of C7 and T1 allowed for C6–C7 and C7–T1 reduction. The left C8 nerve root was entirely exposed due to the lateral mass fracture at C7 and was exposed further to ensure decompression of the C8 roots. A postoperative CT scan demonstrated adequate localization of the instrumentation and alignment despite slight unilateral facet subluxation at C6/C7 and minor unilateral facet subluxation at C7/T1 [
Multiple facet fractures/dislocations occur at all spinal levels in up to 4% of patients sustaining spinal injuries.[
Here, we present the unique case of a 31-year-old male, who sustained bilateral cervical jumped facets (C6/C7 and C7/T1) occurring at two adjacent levels shortly after he had undergone a C6/C7 arthroplasty. Due to the rare entity, surgical reduction and fixation may prove special technical challenges. The authors chose to perform a posterior approach to achieve reduction, decompression, and fusion.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
This work was supported by grants from the Heidi Demetriades Foundation, the ETH Zurich Foundation and by the Henan Provincial People’s Hospital Outstanding Talents Funding Grant Project to AZ.
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