cervical dislocation cervical dislocation

Cervical dislocation: Diagnosis and treatment (Is it serious?)

Article reviewed and approved by Dr. Ibtissama Boukas, physician specializing in family medicine

La cervical dislocation is part of the lesions frequent traumatic spine. But what is it really about? This article will allow you to know more about its definition, its causes, the symptoms of a cervical dislocation, diagnosis and possible treatments.

Definition of Cervical Dislocation


To better understand and define the cervical dislocation, let's see some notions on theanatomy of cervical spine.


The cervical spine is the part of the spine that is located at the level of the neck. It consists of seven vertebrae. Relative movements between these vertebrae mainly take place at small joints (called facet joints) between two vertebrae.


joint pain in the neck


The facet joints facilitate movement of the neck. They are likely to luxate. This can lead to a noticeable loss of function (up to paralysis). Surgery is usually needed to treat these serious injuries to keep the vertebrae in place.


La cervical dislocation is one of traumatic cervical spine injury. It's about displacement of a vertebrate accompanied by rupture of the ligaments. It can involve the vital and functional prognosis of the patient.


Note: Cervical dislocation should not be confused with displaced vertebra. Indeed, the dislocation comes from a traumatic injury, while the "subluxated" or "misaligned" vertebra is often difficult to prove. To learn more about the myth of the displaced vertebra, see the following article.



What are the causes of cervical dislocation?


The cervical facet dislocations usually appear after high intensity shocks such as than :


  • road accidents (often in a context of polytrauma);
  • falls from a high place;
  • high-risk sports (e.g. horse riding);
  • violent attacks...


In about half of the cases, the facet dislocations are accompanied of an impairment of the spinal cord which passes inside the spine. Those are serious injuries; they are often associated with neurological damage (such as quadriplegia).


The mechanism of injury is a hyperflexion with a posterior distraction (frontal impact with sudden deceleration). Most often, this phenomenon is encountered during the mechanism “ whiplash (for example, in a car accident).


 Hyperflexion induces a tensile force on the posterior structures and a compressive force on the anterior part of the spine (vertebral bodies and discs). The lesions caused mainly concern the spinal mobile segment.


Its consequences can be multiple such as neurological disorders: paraplegia or quadriplegia in the case of a dislocation below the 4th cervical vertebra.


What are the symptoms of cervical dislocation?


Clinically, the dislocation of the vertebrae cervical is manifested by:


  • a spinal pain (a neck pain),
  • a painful muscle contracture,
  • a functional impotence of the neck…


On clinical examination, there is spontaneous pain triggered on palpation of the cervical spine with an antero-posterior interspinous discrepancy in stair-step.


The existence of a neurological deficit motor or sensory of the upper and lower limb (without lesion of the cranial pairs) testifies to an unstable lesion. It depends on the vertebral level reached. You can find for example:


  • a spinal cord injury complete : absence of motricity, sensitivity, areflexia below the level of the lesion (tetraplegia);
  • ou incomplete : persistence of a functional neurological territory below the lesion. Neurological examination is sometimes normal, but voluntary movements are regularly accompanied by pain.


When the shock occurs, the patient may feel a creak which bears witness to the ligament tear. He may also experience various sensations such as tingling, electric shocks, the loss of sensitivity (paresthesia), difficulty moving your neck, fingers, or toes (muscular weakness or even paralysis).



Diagnosis of cervical dislocation


Questioning and clinical examination


They allow you to specify:


  • the time and circumstances of the accident, the time frame for treatment, the injury mechanism (wearing a seat belt is important);
  • civil status information (age, gender, etc.);
  • medical and surgical history, usual treatment (anticoagulants, etc.);
  • functional signs: spinal pain, torticollis, respiratory discomfort, weakness of the lower limbs, acute retention of urine, priapism (prolonged erection of the penis)…


physical examination


General examination


It is essential to eliminate a vital emergency (context of polytrauma).


Spine examination


It aims to detect a spinal syndrome (localized pain, segmental stiffness).


On inspection, the doctor looks for the presence of a bruise and a localized deformity (protrusion of a spiny, kyphosis). Then, he goes on to palpate the spines in order to find a painful point. He also palpates the paravertebral muscles looking for an irreducible contracture.


Neurological examination (important)


Very important, the neurological examination is recorded and repeated over time.


The neurological examination is necessary for:


  • check for radicular syndrome (compression). It allows the clinical diagnosis of the lesional level;
  • look for a spinal cord complication: spinal concussion, spinal cord contusion secondary to compression.


Before a patient with post-traumatic paraplegia or tetraplegia, spinal cord section should always be suspected.


To know the procedure related to the neurological examination, see the following article.


X-ray examination


X-ray of the cervical spine


La cervical spine x-ray is a first-line assessment in the context of cervical dislocation.


She understands :


  • an open-mouth face shot: analysis of C2;
  • a profile shot centered on C1 and C2;
  • overall views of the cervical spine face and profile: arms pulled down to clear C7, patient seated;
  • right and left ¾ X-rays: analysis of the intervertebral foramina and articular processes;


CT scan of the spine


It makes it possible to detect anomalies, especially in the event oftransverse process which leads to poor visibility of vertebrates (C6, C7, T1 especially). It is systematically carried out before any fracture with damage to the middle vertebral segment.


The diagnosis is positive if it allows good visualization in the axial plane of the real diameter of the spinal canal, the integrity of the posterior vertebral wall, the lesions of the posterior arch and the disc.


Computed tomography is essential if surgery is planned.


Spine MRI


The doctor generally indicates it in the event of neurological impairment.


Diagnosis is based on finding a lesion of the spinal mobile segment or a compressive element (bone fragment, intervertebral disc, hematoma). The study of the stability of the disco-ligamentous apparatus as well as the assessment of the associated lesions are also important.



Cervical dislocation treatments


The cervical dislocation treatments all aim to:


  • reduce deformations;
  • decompress the nerves;
  • stabilize the spine;
  • manage neurological sequelae.


Depending on the severity of the disease, there are several types of treatments that patients can resort to.


Orthopedic therapeutic means


The reduction


It is often an emergency solution while awaiting surgical stabilization. It is a therapeutic emergency in case of neurological compression or deformation. It must be done in all cases on a patient who is conscious and awake under myorelaxant. It can be: manual or instrumental (instrumental reduction by GARDENER step).


Immobilization of the spine


The immobilization of the spine is carried out by placing a cervical collar or neck brace (in the event of unstable cervical lesions, but without displacement).


For cervical lesions which are both unstable and displaced, the most suitable is the cervical traction with cranial stirrup. However, this form of immobilization should only be carried out following reduction by surgical osteosynthesis or restraint by a collar.


Surgical therapeutic means


Surgical treatment allows:


  • the reduction ;
  • neurological decompression;
  • reconstruction and stabilization by cervical arthrodesis.


The indications for surgical treatment are:


  • the signs of spinal compression or mono-radicular affection not yielding after a reduction;
  • unstable lesions;
  • significant static disturbances or risks of progression to significant static disturbances;
  • major canal stenosis;
  • neurological signs...


There are mainly two surgical steps: reduction et fixation.


The reduction


It aims to return an injured or dislocated bone or joint to its normal anatomical position.




La fixation refers to the medical procedure aimed at stabilizing one or more joints or a fractured bone. It is most often done by devices such as wires, screws, plates, and pins inserted during surgery.


The fixation of the lesion is generally carried out using an anterior or posterior surgical approach.


In the anterior cervical approach, the front of the neck is incised.


In contrast, with the posterior cervical approach, the surgeon makes a midline incision in the back of the neck and through the muscles to the cervical vertebrae. This approach gives direct access to the dislocated facet joints.


Management of neurological sequelae


To prevent skin complications (skin pressure ulcers in support areas), it is preferable to opt for:


  • an anti-decubitus mattress (never sufficient on their own);
  • a change of position every 3 hours;
  • cleanliness treatments and gentle massages of the support areas.


In order to prevent thromboembolic complications, phlebitis and pulmonary embolisms : anticoagulant treatments, elevation and change of position of the lower limbs are necessary.


To avoid orthopedic complications, it's necessary :


  • change position regularly;
  • daily mobilization of paralyzed joints;
  • provide psychological support to the patient.









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