Facet coverage in children on flexion lateral cervical radiographs

Unilateral cervical facet dislocation in a 9-year-old boy

Facet dislocations in children are rare. This article presents the youngest case of a unilateral facet dislocation described in the pediatric population. A 9-year-old boy sustained a flexion/axial loading injury to his cervical spine while wrestling with his friends, causing a unilateral facet dislocation at C4/5. Prereduction magnetic resonance imaging (MRI) demonstrated the absence of a diskal herniation or cord impingement and an intact posterior ligamentous complex. Due to the patient's young age, the decision was made to forgo a supervised awake closed reduction. Closed reduction was performed under general anesthesia with somatosensory-evoked potential and motor-evoked potential monitoring. Closed reduction was successfully achieved after Gardner-Wells tongs were applied and used to manually direct slow, steady in-line traction, along with slight flexion and posterior rotation of the dislocated side under direct fluoroscopy. The patient was immediately awakened from anesthesia and was found to have an intact sensory examination. He was immobilized in a cervical collar for 12 weeks. At 2-year follow-up, he remained asymptomatic without recurrence and had painless full range of motion of the cervical spine. Radiographs revealed a normally aligned cervical spine. Unilateral cervical facet dislocations and subluxations are the result of a distractionflexion force applied to the spine along with a rotational component. These are not uncommon injuries in the adult spine; however, in the young pediatric population, cervical facet dislocations are rare.

Measurement techniques for lower cervical spine injuries: consensus statement of the Spine Trauma Study Group

STUDY DESIGN

Literature review.

OBJECTIVES

It was the purpose of the Spine Trauma Study Group to compile a collection of clinically useful imaging methods used in lower cervical spine trauma and to describe in detail how these measurements should be made.

SUMMARY OF BACKGROUND DATA

Injury detection, description, and treatment decision-making rely on accurate imaging of the lower cervical spine. However, a standard set of imaging measurement techniques for this region does not exist. While most clinicians have developed their own methods of describing radiographic pathology, this variability often leads to confusion in developing an agreed on classification system and limits treatment recommendations.

METHODS

The available literature concerning measurement of injury characteristics after lower cervical trauma was reviewed. Consensus of the most potentially useful measurement methods among the surgeon members of the Spine Trauma Study Group was achieved.

RESULTS

These measurements included the following: kyphosis (Cobb angle and posterior vertebral body tangent methods); vertebral body translation; vertebral body height loss; maximal spinal canal compromise and spinal cord compression; facet fracture fragment size; and percentage facet subluxation.

CONCLUSIONS

A consistent and standard measurement technique among clinicians with regards to imaging of lower cervical spine trauma should positively influence treatment outcome. However, it is through prospective study that the clinical significance of these recommendations will be scientifically established.