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Pediatric cervical facet dislocations are rare and severe neurological injuries

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SAN DIEGO — Pediatric cervical facet dislocations are a rare occurrence that offer little neurological recovery, according to the results of a retrospective study presented here.

Cervical facet dislocations are devastating injuries for pediatric patients with unique features, according to Carlo Bellabarba, MD, but these dislocation are rare in children because of the greater resilience of the pediatric spine.

“Cervical facet dislocations are uncommon in the pediatric population,” he said at the Cervical Spine Research Society Annual Meeting. “We think that is probably because of the fact that the spine is more stable and less susceptible to dislocation, and therefore requires a higher energy mechanism. When they do occur, as a consequence, they tend to have a higher likelihood of severe neurological deficit and a lower likelihood of neurological recovery.”

Bellabarba and colleagues conducted a retrospective review of the 141 patients at Harborview Medical Center who presented with cervical facet dislocations between 2004 and 2014. A total of 21 pediatric patients were identified with either a unilateral or bilateral injury. Most injuries were sustained due to high-energy mechanisms, including motor vehicle accidents, diving into a shallow pool or assaults, he said.

Bellabarba noted 13 out of the 21 patients were “motor complete” and given an American Spine Injury Association (ASIA) A classification. Six patients were neurologically intact and two patients were classified as ASIA D. The most common level of fracture was C6-7, and nine patients also presented with a facet fracture (eight unilateral and one bilateral).

Investigators found one of the 18 patients with a preoperative MRI had a cervical disc herniation, Bellabarba said.  Successful reduction and decompression was achieved in all cases. – by Robert Linnehan

Reference:

Anissipour AK, et al. Presentation #66. Presented at: Cervical Spine Research Society Annual Meeting; Dec. 3-5, 2015; San Diego.

Disclosure: Bellabarba reports no relevant financial disclosures.