Dislocations of the lower cervical spine.

In 34 cases of cervical spine facet dislocation treated between 1975 and 1979, the dislocations were reduced by closed methods and immobilized in the halo thoracic brace. If closed reduction was unsuccessful, open reduction and fusion were performed. There is a high incidence of failure of closed reduction and halo thoracic immobilization in patients with minimal or no neurologic deficit. Bilateral facet dislocation was more frequently associated with severe neurologic injury than was unilateral facet dislocation, Use of closed reduction is time consuming, often unsuccessful, and may result in neurologic deterioration. Patients with facet dislocations and minimal neurologic injury are at risk of late instability following halo thoracic brace immobilization, and therefore open reduction and posterior cervical fusion may be advisable for them. However, surgical fusion carries a high incidence of long-term neck pain and stiffness, and is indicated only in patients at risk of developing late instability.