Traumatic bilateral cervical facet dislocation:a comprehensive review and evidence-based treatment algorithm.
Publication/Presentation Date
6-1-2026
Abstract
PURPOSE: Traumatic bilateral cervical facet dislocation (BFD) represents a high-energy, highly unstable spinal injury with a significant risk of neurological compromise. BFD poses substantial diagnostic and therapeutic challenges across the acute-to-delayed care continuum. Variability in injury morphology, timing of presentation, and patient factors often leads to wide discrepancies in clinical management.
METHODS: This review synthesizes biomechanical principles, diagnostic protocols, classification systems, and surgical strategies from the available literature, with critical appraisal of anterior, posterior, and circumferential approaches. We identify key clinical inflection points, such as the presence of disc extrusion, endplate fracture, irreducibility, and chronicity, that determine optimal intervention. Imaging modalities including CT, MRI, and CT angiography are reviewed in context, and the role of pre-reduction MRI is highlighted in risk mitigation.
RESULTS: A novel treatment algorithm is presented, integrating radiographic findings, neurological status, and timing. In neurologically intact patients with reducible injuries, anterior decompression and fixation offers a safe and efficient pathway. In delayed or fixed dislocations, posterior-first or staged approaches may be necessary, particularly when osteotomies or circumferential correction is warranted. Closed reduction is addressed with caution due to risk of cord injury, especially in the absence of pre-reduction imaging.
CONCLUSION: This article offers a practical framework for spine surgeons navigating the rare but high-stakes scenario of BFD. By consolidating contemporary evidence with expert interpretation, we provide a structured pathway to improve safety, consistency, and neurological outcomes.
Volume
35
Issue
6
First Page
2985
Last Page
2996
ISSN
1432-0932
Published In/Presented At
Haq, I. Z., Fehlings, M. G., Vaccaro, A. R., Furtado, N. R., Wang, B., Upadhyayula, P., LaFuente, J., Casey, A. T. C., Allibone, J. B., & Ganau, M. (2026). Traumatic bilateral cervical facet dislocation:a comprehensive review and evidence-based treatment algorithm. European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 35(6), 2985–2996. https://doi.org/10.1007/s00586-025-09503-7
Disciplines
Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods
PubMedID
41207973
Department(s)
Administration and Leadership
Document Type
Article