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Published in: European Spine Journal 2/2012

01-02-2012 | Original Article

Fracture and contralateral dislocation of the twin facet joints of the lower cervical spine

Authors: Ly Minh Ngo, Toshimi Aizawa, Takeshi Hoshikawa, Yasuhisa Tanaka, Tetsuro Sato, Yushin Ishii, Shoichi Kokubun

Published in: European Spine Journal | Issue 2/2012

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Abstract

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.
Literature
1.
go back to reference Allen BL Jr, Ferguson RL, Lehmann TR, O’Brien RP (1982) A mechanistic classification of closed, indirect fractures and dislocations of the lower cervical spine. Spine 7:1–27PubMedCrossRef Allen BL Jr, Ferguson RL, Lehmann TR, O’Brien RP (1982) A mechanistic classification of closed, indirect fractures and dislocations of the lower cervical spine. Spine 7:1–27PubMedCrossRef
2.
go back to reference Argenson C, Lovet J, Sanouiller JL (1988) Traumatic rotatory displacement of the lower cervical spine. Spine 13:767–773PubMedCrossRef Argenson C, Lovet J, Sanouiller JL (1988) Traumatic rotatory displacement of the lower cervical spine. Spine 13:767–773PubMedCrossRef
3.
go back to reference Argenson C, de Peretti F, Ghabris A, Eude P, Hovorka I (2000) Traumatic rotatory displacement of the lower cervical spine. Bull Hosp Jt Dis 59:52–60PubMed Argenson C, de Peretti F, Ghabris A, Eude P, Hovorka I (2000) Traumatic rotatory displacement of the lower cervical spine. Bull Hosp Jt Dis 59:52–60PubMed
4.
go back to reference Aebi M, Mohler J, Zach GA, Morscher E (1986) Indication, surgical technique, and results of 100 surgically treated fractures and fracture-dislocations of the cervical spine. Clin Orthop 203:244–257PubMed Aebi M, Mohler J, Zach GA, Morscher E (1986) Indication, surgical technique, and results of 100 surgically treated fractures and fracture-dislocations of the cervical spine. Clin Orthop 203:244–257PubMed
5.
go back to reference Braakman R, Vinken PJ (1967) Unilateral facet interlocking in the lower cervical spine. J Bone Joint Surg Br 49:249–257PubMed Braakman R, Vinken PJ (1967) Unilateral facet interlocking in the lower cervical spine. J Bone Joint Surg Br 49:249–257PubMed
6.
go back to reference Crawford NR, Duggal N, Chamberlain RH, Park SC, Sonntag VKH, Dickman CA (2002) Unilateral cervical facet dislocation: Injury mechanism and biomechanical consequences. Spine 27:1858–1864PubMedCrossRef Crawford NR, Duggal N, Chamberlain RH, Park SC, Sonntag VKH, Dickman CA (2002) Unilateral cervical facet dislocation: Injury mechanism and biomechanical consequences. Spine 27:1858–1864PubMedCrossRef
7.
go back to reference Forsyth HF (1964) Extension injuries of the cervical spine. J Bone Joint Surg Am 46:1792–1797PubMed Forsyth HF (1964) Extension injuries of the cervical spine. J Bone Joint Surg Am 46:1792–1797PubMed
8.
go back to reference Frankel HL, Hancock DO, Hyslop G, Melzak J, Michaelis LS, Ungar GH et al (1969) The value of postural reduction in the management of closed injuries of the spine with paraplegia and tetraplegia. Paraplegia 7:179–192PubMedCrossRef Frankel HL, Hancock DO, Hyslop G, Melzak J, Michaelis LS, Ungar GH et al (1969) The value of postural reduction in the management of closed injuries of the spine with paraplegia and tetraplegia. Paraplegia 7:179–192PubMedCrossRef
9.
go back to reference Harris JH, Edeiken-Monroe B, Kopaniky DR (1986) A practical classification of acute cervical spine injuries. Orthop Clin North Am 17:15–30PubMed Harris JH, Edeiken-Monroe B, Kopaniky DR (1986) A practical classification of acute cervical spine injuries. Orthop Clin North Am 17:15–30PubMed
10.
go back to reference Judet R, Judet J, Roy-Camille R, Zerah J-C (1970) Saillant G (1970) Fractures du rachis cervical: fracture-séparation du massif articulaire. Rev Chir Orthop 56:155–164PubMed Judet R, Judet J, Roy-Camille R, Zerah J-C (1970) Saillant G (1970) Fractures du rachis cervical: fracture-séparation du massif articulaire. Rev Chir Orthop 56:155–164PubMed
11.
go back to reference Kotani Y, Abumi K, Ito M, Minami A (2005) Cervical spine injuries associated with lateral mass and facet joint fractures: new classification and surgical treatment with pedicle screw fixation. Eur Spine J 14:69–77PubMedCrossRef Kotani Y, Abumi K, Ito M, Minami A (2005) Cervical spine injuries associated with lateral mass and facet joint fractures: new classification and surgical treatment with pedicle screw fixation. Eur Spine J 14:69–77PubMedCrossRef
12.
go back to reference Kwon BK, Vaccaro AR, Grauer JN, Fisher CG, Dvorak MF (2006) Subaxial cervical spine trauma. J Am Acad Orthop Surg 14:78–89PubMed Kwon BK, Vaccaro AR, Grauer JN, Fisher CG, Dvorak MF (2006) Subaxial cervical spine trauma. J Am Acad Orthop Surg 14:78–89PubMed
13.
go back to reference Lee C, Kim KS, Roger LF (1982) Triangular cervical vertebral body fractures: diagnostic significance. Am J Roentgenol 138:1123–1132 Lee C, Kim KS, Roger LF (1982) Triangular cervical vertebral body fractures: diagnostic significance. Am J Roentgenol 138:1123–1132
14.
go back to reference Magerl F, Aebi M, Gertzbein SD, Harms J, Nazarian S (1994) A comprehensive classification of thoracic and lumbar injuries. Euro Spine J 3:184–201CrossRef Magerl F, Aebi M, Gertzbein SD, Harms J, Nazarian S (1994) A comprehensive classification of thoracic and lumbar injuries. Euro Spine J 3:184–201CrossRef
15.
go back to reference Nieminen R (1974) Fractures of the articular processes of the lower cervical spine: an analysis of 28 cases treated conservatively. Ann Chir Gynaecol Fenn 63:204–211PubMed Nieminen R (1974) Fractures of the articular processes of the lower cervical spine: an analysis of 28 cases treated conservatively. Ann Chir Gynaecol Fenn 63:204–211PubMed
16.
go back to reference Orthpaedic Trauma Association. Fracture and dislocation compedium (1996) J Orthop Trauma 10 (Suppl 1):1–154 Orthpaedic Trauma Association. Fracture and dislocation compedium (1996) J Orthop Trauma 10 (Suppl 1):1–154
17.
go back to reference 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:E8 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:E8
18.
go back to reference Rabb CH, Lopez J, Beauchamp K, Witt P, Bolles G, Dwyer A (2007) Unilateral cervical facet fractures with subluxation: injury patterns and treatment. J Spinal Disord Tech 20:416–422PubMedCrossRef Rabb CH, Lopez J, Beauchamp K, Witt P, Bolles G, Dwyer A (2007) Unilateral cervical facet fractures with subluxation: injury patterns and treatment. J Spinal Disord Tech 20:416–422PubMedCrossRef
19.
go back to reference Rogers WA (1942) Treatment of fracture-dislocation of the cervical spine. J Bone Joint Surg 24:245–258 Rogers WA (1942) Treatment of fracture-dislocation of the cervical spine. J Bone Joint Surg 24:245–258
20.
go back to reference Rorabeck CH, Rock MG, Hawkins RJ, Bourne RB (1987) Unilateral facet dislocation of the cervical spine: an analysis of the results of treatment in 26 patients. Spine 12:23–27PubMedCrossRef Rorabeck CH, Rock MG, Hawkins RJ, Bourne RB (1987) Unilateral facet dislocation of the cervical spine: an analysis of the results of treatment in 26 patients. Spine 12:23–27PubMedCrossRef
21.
go back to reference Signoret F, Jacquot F, Feron JM (1999) Reducing the cervical flexion teardrop fracture with a posterior approach and plating technique. An original method. Eur Spine J 8:110–117PubMedCrossRef Signoret F, Jacquot F, Feron JM (1999) Reducing the cervical flexion teardrop fracture with a posterior approach and plating technique. An original method. Eur Spine J 8:110–117PubMedCrossRef
22.
go back to reference 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 163:1165–1169 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 163:1165–1169
23.
go back to reference Torg JS, Pavlov H, O’Neill MJ, Nichols CE, Sennett B (1991) The axial load teardrop fracture. A biomechanical, clinical, and roentgenographic analysis. Am J Sport Med 19:355–364CrossRef Torg JS, Pavlov H, O’Neill MJ, Nichols CE, Sennett B (1991) The axial load teardrop fracture. A biomechanical, clinical, and roentgenographic analysis. Am J Sport Med 19:355–364CrossRef
24.
go back to reference 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) 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)
26.
go back to reference Whitley JF, Forsyth FH (1960) The classification of the cervical spine injuries. Am J Roentgenol 83:633–644 Whitley JF, Forsyth FH (1960) The classification of the cervical spine injuries. Am J Roentgenol 83:633–644
27.
go back to reference White A, Panjabi M (1990) Kinetics of the spine. In: Clinical Biomechanics of the Spine, 2nd edn. JB Lippincott, Philadelphia, pp 85–126 White A, Panjabi M (1990) Kinetics of the spine. In: Clinical Biomechanics of the Spine, 2nd edn. JB Lippincott, Philadelphia, pp 85–126
28.
go back to reference Watts C, Smith H, Knoller N (1993) Risks and cost-effectiveness of sublaminar wiring in posterior fusion of cervical spine trauma. Surg Neurol 40:457–460PubMedCrossRef Watts C, Smith H, Knoller N (1993) Risks and cost-effectiveness of sublaminar wiring in posterior fusion of cervical spine trauma. Surg Neurol 40:457–460PubMedCrossRef
Metadata
Title
Fracture and contralateral dislocation of the twin facet joints of the lower cervical spine
Authors
Ly Minh Ngo
Toshimi Aizawa
Takeshi Hoshikawa
Yasuhisa Tanaka
Tetsuro Sato
Yushin Ishii
Shoichi Kokubun
Publication date
01-02-2012
Publisher
Springer-Verlag
Published in
European Spine Journal / Issue 2/2012
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI
https://doi.org/10.1007/s00586-011-1956-6

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