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Reduction of Jumped Facet(s)

- Discussion:
     - treatment of jump locked or perched facets is reduction by halo traction and then placement of a halo jacket;
     - closed reduction usually succeeds;

- Diff Dx:
     - prior to attempted reduction ensure that the diagnosis is correct;
     - the differential diagnosis should include pure cervical distraction injuries which at first glance can resemble a facet dislocation;
              - this type of injury should not be managed w/ halo traction since this would be expected to only worsen the injury;

- Pre-Reduction Considerations:
    - w/ facet joint subluxation in an alert and cooperative patient consider immediate reduction w/o MRI;
    - some surgeons, however, recommend MRI imaging before reduction or operative intervention is attempted;
    - facet dislocations, frequently are accompanied by disc herniation into anterior part of the spinal canal;
           - marked protrusion of disc material into spinal canal may occur in about 10% of pts who had subluxation or dislocation 
                  of a cervical facet;
                  - in pts who have such injury, catastrophic compression of spinal cord can result from an uncontrolled facet reduction;
                  - in this case, consider anterior discectomy and fusion followed by posterior fusion;

- Monitoring of Neuro Status:
    - pt must be admitted to intensive care unit or setting w/ one to one nursing care to monitor his neurologic status;
    - reduction is done w/ close monitoring of neurological & x-ray status of pt, preferably when pt is awake and alert.

- Traction Force (needed amount is variable);
    - skeletal traction, positioning, & postural bumps assist reduction;
    - up to one third of body weight may be required;
    - safe upper limits have not been established, although published reports include forces up to 60-75 lbs;
    - wt is added incrementally, w/ x-rays being made after each addition;
    - begin w/:
          - 10 lbs is added for occiput;
          - additional 5 lbs, for ea vertebra to level of injury;
           - but begin w/ < 20 libs;
    - re-evaluation:
         - after placement of wt, check lateral X-ray & full Neuro Exam;
         - if reduction does not occur, wt. is then added in 5 lbs increments, in approximate half hour intervals, being certain to repeat
         lateral X-ray and the Neuro Exam after each wt. increase;
    - max amount of traction wt that can be applied safely is unknown;
          - up to 20 lbs can be applied to C1 & C2;
          - up to 50 lbs can be applied in lower cervical region (C3-C7);
          - if the reduction does not occur after using 35-40 lbs, ORIF and fusion is indicated;
                - some recommend a much greater force be used;
    - once reduction has been achieved, traction wt can be reduced to 20 lbs (9.1 kg) or less to maintain alignment;

- Failed Reduction:
    - w/ neurological deficit unsuccessful reduction by 3-6 hrs after trauma is an indication of open reduction and stabilization;
    - closed reduction attempts are discontinued when:
          - reduction is achieved
          - when > 1 cm of distraction occurs at site of injury;
          - when neurological status of pt deteriorates;
          - when maximum amount of weight is applied;
    - redislocation:
          - prevented w/ moderate cervical extension & traction

Year Book: Closed Reduction of Cervical Spine Dislocations.

Rapid traction for reduction of cervical spine dislocations.

Neurological deterioration after reduction of cervical subluxation. Mechanical compression by disc tissue.

Extrusion of an intravertebral disc associated with traumatic subluxation or dislocation of cervical facets: Case report.