Unilateral cervical facet dislocation: Injury mechanism and biomechanical consequences

Study Design. Human cadaveric cervical spines were subjected to nondestructive repeated-measures flexibility tests before, during, and after unilateral facet dislocation. Objectives. To assess the relative stability and kinematics of the spine in the normal condition, after unilateral facet lock without bony injury and after reducing (unlocking) the facet dislocation. Summary of Background Data. Experimental unilateral facet dislocation has been studied only when associated with extensive damage to disc, bone, or both. The relative stability of the normal, locked, and unlocked cervical spine has not been studied. Methods. Unilateral facet dislocation with minimal associated injury was created by slowly applying axial torque while specimens were bent laterally and flexed. Before and after injury, nondestructive torques were applied about each anatomic axis, while three-dimensional specimen motion was recorded stereophotogrammetrically. Results. Unilateral facet dislocation was created with a mean axial torque of 10.2+/-2.7 Nm. After locking, range of motion, lax zone, and stiff zone were significantly reduced relative to normal (P < 0.05). After unlocking, the same parameters were significantly increased relative to normal. The position of the axis of rotation shifted when the facet was locked and the centrode elongated after the facet was unlocked. Conclusions. Unilateral facet dislocation without fracture can be created with moderate loads when axial torque is applied while the facet is distracted. The spine is stable while the articular masses are locked unilaterally; however, the motion segment becomes overtly unstable after the facet dislocation is reduced.