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Cervical Facet Dislocation: When Is Magnetic Resonance Imaging Indicated?

Hart, Robert A., MD; Vaccaro, Alexander R., MD; Nachwalter, Richard S., MD

Section Editor(s): McLain, Robert F. MD, Associate Editor Spine Controversies

Controversies in Spine

Acknowledgment date: June 4, 2001.

First revision date: July 25, 2001.

Acceptance date: July 30, 2001.

The treatment of cervical facet dislocation is not controversial, but the need for magnetic resonance imaging (MRI) before reduction is a matter of debate. The primary concern is that an unrecognized cervical disc herniation may produce a compressive spinal cord injury if reduction is performed before decompression. Sporadic reports of catastrophic neural injury lend credence to the concern that reduction in a neurologically intact patient before MRI introduces unnecessary risk into the treatment plan. Large series of patients have been treated successfully without imaging, however, suggesting that the potential for inadvertent injury is low. Dr. Vaccaro bases his opinion that MRI is unnecessary in many cases on extensive clinical experience and prospective clinical data. Dr. Hart defends the position that MRI is crucial, basing his argument on the supreme cost incurred if the diagnosis is missed even rarely. Spine 2002;27:116–118

© 2002 Lippincott Williams & Wilkins, Inc.