Approach to the Critical Patient

Immediate priorities

Airway and cervical spine threats

Neurogenic shock recognition

Stabilization and monitoring

Spinal motion restriction

Monitoring bundle

Team activation and consults

Immediate specialist triggers

Key decision points

Pre-reduction MRI controversy

Bilateral vs unilateral severity stratification

History

Mechanism and onset

High-energy trauma mechanisms

Neurological symptoms

Motor deficits

Sensory symptoms

Associated symptoms

Neck pain and deformity

Dyspnea or respiratory difficulty

Autonomic features

Risk factors and past history

Pre-existing spinal conditions

Patient demographics

Medications and substances

Physical Exam

Primary survey findings

ATLS priorities with spinal motion restriction

Neurological examination

ASIA/AIS motor assessment

Sensory examination

Reflexes and sacral function

Cervical spine exam

Midline tenderness

Paraspinal muscle spasm

Torticollis pattern

Systemic and associated findings

Priapism

Skin and trunk exam

PITFALLS

Differential Diagnosis

Unstable cervical spine injuries

Bilateral facet dislocation

Unilateral facet dislocation

Burst fracture

Facet fracture variants

Facet fracture without dislocation

Teardrop fracture

Other cervical fractures

Hangman fracture (C2 pars)

Jefferson fracture (C1 burst)

Soft tissue and ligamentous injuries

Ligamentous injury without fracture

Traumatic disc herniation

Associated vascular injuries

Vertebral artery injury

Blunt cerebrovascular injury (BCVI)

Laboratory Tests

Initial trauma labs

Complete blood count

Metabolic panel

Coagulation studies

Organ perfusion and shock labs

Lactate

Arterial blood gas

Venous blood gas

Adjunct and toxicology labs

Blood alcohol level and urine toxicology

Urinalysis

ECG

Diagnostic Tests

Scoring Systems

SLIC (Subaxial Injury Classification and Severity Score)

ASIA Impairment Scale (AIS)

AO Spine Subaxial Classification

NEXUS and Canadian C-Spine Rule

MRI

MRI cervical spine indications

MRI findings and significance

MRI protocol

CT

CT cervical spine without contrast

CT angiography (CTA) of the neck

Ultrasound

Limited primary role in facet dislocation

POCUS vascular assessment

Soft tissue ultrasound

Disposition

Admission criteria

All true facet dislocations require admission

Level of care selection

ICU indications

Step-down or floor admission

Specialist consultations

Required consultations

Adjunct consultations

Discharge criteria

Discharge not applicable acutely for true dislocations

Treatment

Immediate resuscitation

Hemodynamic support in neurogenic shock

Closed reduction (skull traction)

Gardner-Wells tong traction

Surgical management

Anterior approach (ACDF with plating)

Posterior approach (lateral mass or pedicle screw fixation)

Combined anterior-posterior approach

Non-operative management

Selected stable injuries only

Conservative reoperation rate

Neuroprotection and SCI management

MAP augmentation

Methylprednisolone

DVT prophylaxis in SCI

Pain management

Acute pain

Neuropathic pain in SCI

Special Populations

Pregnancy

Pregnancy and cervical facet dislocation

Geriatric

Older adults and facet dislocation

Pediatrics

Children and adolescents with facet dislocation

Background

Epidemiology

Incidence and distribution

SCI burden and outcomes

Vertebral artery injury prevalence

Pathophysiology

Mechanism of injury

Spinal cord injury mechanism

Vertebral artery injury mechanism

Therapeutic Considerations

Reduction vs stabilization decision

Neuroprotection evidence base

Vertebral artery injury management

Patient Discharge Instructions

copy discharge instructions

Facet dislocation discharge care

Warning signs requiring immediate return to the ER

Follow-up appointments

References

Guidelines and key sources

Primary clinical guidelines

Key epidemiology and outcome studies

Vertebral artery injury references

Imaging and classification references

Surgical technique references

ICD-10 coding