bilateral locked facets
bilateral locked facetsA lower-cervical (C7/T1) injury resulting in subluxation with locking of both facets due to hyperflexion; 90% of patients with BLFs have a neurologic injury; two-thirds of patients have a complete spinal cord injury, one-fourth have myelopathy. Bilateral locked facets also occur in the lower lumbar spine.
Rapid skull traction followed by closed reduction for cervical locked facets; early surgery with open reduction, fixation and fusion for lower lumbar locked facets. If the subluxation on the lateral cervical spine film is ≥ 50% BFL should be suspected. During reduction of the locked facets, the operator should seek to avoid increasing pain, neurologic deficit and separation at the level above the injury; the subluxation should be reduced as soon as possible, ideally within the first 24 hours, using cervical traction and reduction. BLFs are highly unstable and should be treated with cervical fusion; these patients should have an MRI before surgery to rule out herniated cervical disc, and, if present, an anterior fusion is required; otherwise, posterior cervical fusion with wire, cable, or plates.