Bilateral facet joint dislocation of cervical spine
Introduction
Introduction to bilateral dislocation of the facet joint of the cervical spine Bilateral facet joint dislocation of the cervical spine is a typical flexion injury that can occur in any segment between the neck 2 and the chest 1, but is most common in the segment below the neck 4. The disease is more common in high places, falling head and neck hitting the ground or heavy objects directly attacking the neck of the pillow. The whiplash-like violence can also cause dislocation. basic knowledge Sickness ratio: 0.0001% Susceptible people: no specific population Mode of infection: non-infectious Complications: skin allergies
Cause
Causes of bilateral dislocation of the facet joint of the cervical spine
The disease is more common in the fall, the head and neck hit the ground, or the heavy object directly attacks, causing the neck of the pillow to be subjected to flexing violence, and the whiplash-like damage can also cause dislocation. When the vehicles driving at high speed gather to brake, The head and neck are fiercely flexed due to inertia. When the head and neck are subjected to flexion violence, the fulcrum of the cervical vertebra activity unit is located at the posterior part of the center of the intervertebral disc. Because the facet joint of the cervical vertebra is flat and at an angle of 45° to the horizontal plane, sudden buckling The external side causes the inferior articular process of the upper cervical vertebra to advance and tear the joint capsule, and then tilts back and forth. As the external force continues and the inertia of the head weight, the displaced lower articular process continues to move forward. Sliding, the entire upper vertebral body also moves with the previous movement. After the force disappears, due to the contraction of the neck muscle, three states can be formed: one is to reset, and the cervical instability or the subluxation state after the injury may occur in the future; Second, the cervical dislocation is elastically fixed, the upper and lower facet joints are mutually dependent, forming a top-to-top "perch" state; the third is the superior sub-articular procession over the upper joint of the lower vertebral body. The shape of the small joints back to back, the so-called "interlocking" state.
Prevention
Prevention of bilateral dislocation of the facet joint of the cervical spine
Pay attention to the safety of production and life, prevent neck trauma, and also pay attention to the bilateral dislocation of the lower cervical vertebrae. Restoration as early as possible is an important measure to protect the spinal cord function and prevent further damage. Therefore, once the disease is diagnosed, it should be actively reset. Or surgical treatment to prevent spinal cord injury, minimize spinal cord compression time, reduce secondary damage, and create conditions for the recovery of neurological function.
Complication
Complications of bilateral facet joint dislocation of the cervical spine Complications, skin allergies
The main cause of this disease is concurrent with some nerve damage. Due to the mutual displacement of the vertebral bodies, the morphology of the spinal canal is seriously damaged, the spinal canal is reduced in the corresponding plane, and the spinal cord is pressed against the posterior vertebral body of the upper vertebra and the posterior vertebral body. Injury, it can cause transverse injury of the spinal cord in severe cases, and symptoms of nerve spinal cord injury may occur, which are manifested as symptoms of the corresponding segments, such as quadriplegia, lower extremity spasm or incomplete paralysis, nerve root injury, showing the nerve The skin in the root area is allergic to skin, pain or sensation.
Symptom
Symptoms of bilateral joint dislocation of the cervical spine Common symptoms Nerve root injury Head and neck activity limitation Cervical pain Head and neck pain
(1) Local performance
The neck is in a forced position. Due to the interlocking of the small joints, the head and neck are forced to flex forward and elastically fixed. The head and neck are severely painful. The tensile stress and tensile stress of the soft tissue around the joint are greatly increased due to the dislocation state. The pain is exacerbated, and the muscles in the neck are obviously paralyzed due to pain and mechanical abnormalities in the injured segment; the head cannot be passively active; the neck has a wide range of tenderness.
(2) Neurological spinal cord injury symptoms
Symptoms of the corresponding segments, such as quadriplegia, paralysis of the lower extremities or incomplete paralysis, with nerve root injury, showing skin allergies, pain or loss of sensation in the area of the nerve root distribution.
Examine
Examination of bilateral dislocation of the facet joint of the cervical spine
There are two main methods for examining this disease:
1, X-ray inspection
The typical signs of lateral X-ray films are: the displacement of the dislocated vertebral body is 2/5 of the anteroposterior diameter of the vertebral body, and the lower articular process of the upper cervical vertebra is located at the top or the front of the lower cervical vertebrae. As the distance increases, the anterior and posterior slices show a disordered relationship between the hook and the joints, and the relationship between the small joints is unclear. The oblique slices show the deformation of the nerve holes, and the tomography is more conducive to diagnosis.
2, MRI examination
The spinal canal can be found, and the spinal cord is subjected to different degrees of compression. If there is damage and edema, it can also be manifested by changes in the signal.
Diagnosis
Diagnosis and diagnosis of bilateral dislocation of the facet joint of the cervical spine
diagnosis
In the history of trauma, you should know whether there is violence that causes extreme flexion of the cervical vertebrae; such as a fall injury with a head down; a sudden brake while riding a car; a head and neck impact injury of a football player, in addition to pay attention to the rotation of the head and neck at the moment of injury X-ray characteristic performance in image examination is the key to diagnosis.
Differential diagnosis
1. Different damage mechanisms
The anterior dislocation of the bilateral facet joints is mainly due to flexion violence, and there is a reversal of violence in addition to flexion violence in the unilateral facet joint dislocation.
2, clinical manifestations are different
Bilateral facet joint dislocation mainly manifested as anterior tilt fixation and extensive tenderness; most of the patients with spinal cord injury, unilateral facet joint dislocation with rotation fixation, tenderness is not extensive, a small number of spinal cord injury, but local pain.
3, X-ray performance is different
The distance of anterior movement of the vertebral body of the bilateral dislocation is often 2/5 or 1/2 of the anterior and posterior position of the vertebral body. The lower articular process of the upper cervical vertebra is located at the top or the front of the lower cervical superior articular process, while the unilateral joint The anterior movement of the vertebral body in the injured segment of the joint dislocation is about 1/3 of the anteroposterior diameter. The orthotopic slice can be seen in the dislocation of the spine.
