Bilateral cervical facet dislocation without neurological injury.

sent significant high-energy trauma to the cervical spine. Neurological morbidity is common, occurring in up to 85% to 90% of cases, and usually is severe among patients with bilateral facet injury.1 Treatment of these injuries is directed at emergent reduction and stabilization of the spine to prevent worsening of any preexisting neurological deficits. Rupture of the posterior longitudinal ligament and annulus fibrosus with an associated disk herniation is common after bilateral facet dislocations.2 Previous studies have shown these herniations can reduce the space for the spinal cord within the canal and can contribute to neurological worsening following a reduction.3 Because of this possibility, many investigators have recommended the importance of obtaining prereduction imaging studies including magnetic resonance imaging (MRI).4 However, other studies suggest significant neurological worsening following reduction is rare and its relation to intervertebral disk herniation has not been well established.5 Thus, an argument can be made that the delay in reduction required to obtain MRI justifies foregoing the MRI study for expeditious reduction of cord compression caused by the persistent dislocation. Animal research has shown the extent of neurological injury after spinal cord compression is related to both the rate of injury and the duration of compression.3 Basic animal research also has demonstrated a relatively brief window of 1 to 3 hours is available, after which injury to the spinal cord caused by mechanical compression may become irreversible.6 Patients who present with an incomplete neurological injury represent a more difficult situation in the decisionmaking process because the time required to obtain a prereduction MRI can be as long as several hours and thus the potential to cause further neurological injury in these patients is real. This article reports a rare case of bilateral cervical facet dislocation in an elderly patient who remained neurologically intact.