SAQ 338 – Trauma – cervical facet dislocation with neurogenic shock
Model Answer
Trauma – cervical facet dislocation with neurogenic shock.
a. CT findings
- Anterior displacement/anterolisthesis of C4 on C5 without obvious fracture.
- Narrowing of the vertebral canal/foramen at this level.
b. Diagnosis
- Bilateral facet joint dislocation.
c. Unstable cervical-spine patterns
- Atlanto-axial dislocation or dissociation.
- Jefferson fracture: burst fracture of C1.
- Hangman fracture: bilateral C2 pedicle fracture.
- Type 2 or type 3 odontoid fracture.
- Teardrop fracture.
- Bilateral facet joint dislocation.
d. Spinal versus neurogenic shock
| Spinal shock | Neurogenic shock |
|---|---|
| Neurological response to acute cord injury, with a period of cord dysfunction that may overestimate permanent deficit. | Distributive shock due to loss of sympathetic tone. |
| Areflexia. | Bradycardia and hypotension. |
| Flaccid paralysis. | Warm skin and poikilothermia, often hypothermia in hospital. |
e. Level
- Usually with injuries above T6.
f. Supportive care
- Immobilise the injury and provide analgesia and antiemetics.
- Maintain MAP 85-90 mmHg using IV Hartmann's 1-2 L, then noradrenaline infusion if needed.
- Maintain normoxia, normoglycaemia, and normothermia.
- Insert IDC, provide pressure-area care, and VTE prophylaxis.
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