Cervical Facet Dislocations After Blunt Trauma and Vertebral Artery Injury.

INTRODUCTION

The goal was to analyze patients with a cervical facet dislocation (CFD) after blunt trauma with focus on vertebral artery injury (VAI).

METHODS

This Institutional Review Board-approved retrospective cohort study comprised 394 adult patients with blunt cervical spine trauma and neurological deficit admitted to two level 1 trauma centers (2015-2024). Analyzed variables included: age, sex, mechanism of injury, Injury Severity Score, Glasgow Coma Scale, abbreviated injury score, coinjuries, American Spinal Injury Association grade, type and location of the CFD, presence of VAI, timing of cervical spine interventions, intensive care unit admissions, hospital lengths of stay, and mortality. Analysis also included multivariable logistic regression to determine the predictors of VAI and mortality.

RESULTS

CFD were present in 19.0% (75/394) of patients with cervical spine trauma. The most common CFD location was at the C5/C6 level. The presence of CFD and paravertebral hematoma was independent predictors of VAI in all patients with cervical spine injuries. Patients with CFD were more severely injured, required more treatment efforts, and had higher mortality than patients without CFD. VAI was present in 13.3% (10/75) of patients with CFD. On multivariable analysis, both the maxillofacial coinjury (odds ratio 53.7, 95% confidence interval [CI] 4.1-705.7, P < 0.001) and paravertebral hematoma (odds ratio 14.9, 95% CI 1.5-150.2, P = 0.004) were found to be independent predictors of VAI in patients with CFD.

CONCLUSIONS

CFD occurred in 19% of patients with cervical spine injury. VAI was found in 13% of patients with CFD. Maxillofacial coinjury and paravertebral hematoma were independent predictors of VAI in patients with CFD.