Management of the neglected and healed bilateral cervical facet dislocation.

Introduction: There is limited literature on the management of neglected healed (fused) bilateral cervical facet dislocation. The authors report a case of a middle aged male who developed a bilateral facet dislocation but only sought treatment 14 months post injury when he experienced pain and deformity in the cervical spine.

Case Report: A 42-year-old male was pushed into a 1.2-m pool by accident and hit his head on the bottom. He immediately felt a sharp pain in his neck but was able to get out of the pool by himself and at the emergency department was found to have no neurological deficit. Standard trauma radiographs were performed and a grade 1 anterolisthesis of C4 on C5 was observed without any facet subluxation or dislocation. An emergent Magnetic Resonance Imaging (MRI) of the cervical spine confirmed X-ray results and in addition demonstrated injury to the posterior ligament complex and a broad-based posterior disc bulge. Computed Tomography (CT) scans revealed no facet dislocation or fractures. Unfortunately, the patient failed to come for his follow-up visits and at 14 months post injury, represented with pain and deformity with impairment of horizontal gaze. Computed tomography and MRI demonstrated a fused (bony) bilateral facet dislocation at C4/5. A cervical spine reconstruction consisting of a posterior-anterior-posterior approach was performed to address both the deformity and the pain. At 32-month follow-up, the patient remains well with no neurological symptoms, minimal neck pain and successful fusion.

Conclusion: Current literature does not offer a clear solution to the management of healed neglected bilateral cervical facet dislocation. The presence of circumferential bony fusion around the deformity necessitates a posterior and anterior release and subsequent stabilization to address this complex problem. We also wish to highlight the order of the reconstructive approach and the need to recognize instability of the cervical spine despite normal CT scans in order to prevent late deformity.