Open Reduction in Cervical Facet Dislocation Does Not Delay Time to Treatment

Introduction: Cervical facet dislocation is a serious injury that can result in devastating neurologic damage. Current CNS guidelines recommend immediate closed reduction of cervical dislocations in many patients, though the efficacy of this practice remains a debate. Closed reduction can lead to neurologic deficits, and most patients require future surgery for lasting fixation. This study evaluates whether immediate open reduction of cervical dislocations offers improved outcomes and limits the need for follow-up operations.

Methods: This is a retrospective cohort study of patients presenting to a single institution from 2010-2023 with cervical facet dislocation and/or fracture. Patients were divided into groups based on initial treatment: open or closed reduction. Time to surgery was calculated as time between arrival to the ED and incision time in the OR. Measured outcomes were improvement in motor weakness, sensory loss, and pain at 6-week post-operative follow-up.

Results: There were 35 patients who met inclusion criteria. The cohort was predominantly male (74%) but did not differ significantly in other demographic factors. Average time to surgery with open reduction was 9 hours. Time to treatment did not differ significantly between the open vs. closed reduction groups (p=0.33). There were no differences between groups in improvement in motor and sensory function at 6 weeks, but the open reduction group was more likely to have improvement in pain at follow-up (p=0.01). Of patients treated with immediate open reduction, 44% showed improvement in ASIA grade, and the remaining 56% had equal ASIA grade at follow-up. 75% of patients with closed reduction required follow-up spine surgery.

Conclusion : Immediate open reduction did not increase time to treatment for patients with cervical facet dislocations. Patients had equivalent motor and sensory outcomes compared to the group treated with initial closed reduction and experienced better pain control at post-operative follow-up. These initial findings suggest that current practice guidelines may delay definitive treatment for these patients without improving patient safety or outcomes. More work is warranted to further investigate the efficacy of immediate open reduction for cervical dislocations.