MANAGEMENT OF UNILATERAL LOCKED FACET OF THE CERVICAL-SPINE

TWENTY-FOUR PATIENTS WITH unilateral cervical locked facets were treat ed between 1986 and 1990. The primary mechanisms of injury were vehicu lar accidents (58%) and altercations (38%). The level of unilateral fa cet dislocation was CS-C6 (41%), C6-C7 (25%), C3-C4 (17%), and C4-C5 ( 17%). Seventeen (70%) came to the hospital with radiculopathy, five (2 0%) were normal, and two (10%) had spinal cord injuries. Plain films s howed subluxation but no fracture. All patients had a cervical compute d tomographic scan. Fracture in addition to facet locking was seen in 12 (50%) of 24 scans: 5 with facet fracture, 4 with facet/laminar frac tures, 2 with facet/laminar/body fractures, and 1 foramen transversari um fracture. On the basis of CT findings, closed reduction was thought to be contraindicated in two cases. Five patients (22%) underwent suc cessful closed reductions. Two of the patients with closed reductions were placed in a halo but again had subluxation. Thus, 24 patients und erwent surgery for open reduction, posterior spinous process wire fixa tion, and facet wiring to struts of the iliac crest for bony fusion. T he initial surgery was successful in 23 (96%) of 24 patients. One pati ent experienced subluxation and underwent further surgery for anterior cervical fusion/plating. Two wound infections were treated, and there were no deaths or neurological worsening. At 1 year, all deficits had improved. Of 16 radiculopathies, 3 (19%) had persistent 4/5 weakness, and the rest were normal, including 2 delayed-diagnosis patients who both showed improvement from 2/5 to 5/5 strength within 1 week of surg ery. Two spinal cord injuries were a central cord injury with persiste nt bilateral intrinsic hand muscle weakness and a Brown-Sequard injury , initially 1/5, that improved to 4/5 strength. Persistent neck pain w as seen in 4 (17%) of 24 cases. A cervical computed tomographic scan p rovided information that aided in the diagnosis and management. Our ex perience, along with a review of the literature strongly suggests that reduction and internal fixation/bony fusion is most successful for th is injury.