Lumbar Bilateral Complete Facet Dislocation

Lumbar bilateral complete facet dislocation is a rare but serious injury in which both sets of facet joints (the small joints that connect one vertebra to the next) at a lumbar (lower back) spinal level are fully displaced from their normal positions. This injury is usually the result of a high-energy force that tears the supporting ligaments and capsule around the facet joints, rendering the spinal segment grossly unstable. Because the facets “lock” out of place, the vertebral body may shift forward or backward, risking damage to the spinal cord or nerve roots. Early recognition and prompt surgical stabilization are critical to prevent permanent nerve injury or paralysis.

Lumbar bilateral complete facet dislocation is a serious injury of the lower spine in which the small joints (facets) on both sides of one vertebra are completely forced out of place relative to the vertebra below. This often results from high-energy trauma such as a car accident or fall from height. When both facet joints dislocate, the spinal canal can narrow significantly, leading to nerve compression and, in severe cases, paralysis. Prompt diagnosis and treatment are essential to prevent long-term disability and chronic pain.


Types

Clinicians recognize several subtypes of lumbar bilateral complete facet dislocation, classified by level, associated injuries, and direction of displacement:

  1. Level-Specific Dislocations

    • L1–L2 through L5–S1: Dislocation can occur at any lumbar level, but L4–L5 and L5–S1 are most common due to mobility. Each level has unique biomechanical stresses and potential complications.

  2. Anterior vs. Posterior Displacement

    • Anterior Dislocation: The upper vertebra shifts forward relative to the one below, often compressing nerve roots in the canal.

    • Posterior Dislocation: More rare, the upper vertebra moves backward, potentially stretching or kinking nerve roots.

  3. Pure Facet Dislocation vs. Fracture-Dislocation

    • Pure Dislocation: Facet capsules and ligaments fail without associated bony fractures.

    • Fracture-Dislocation: Accompanied by fractures of the facet, pedicle, or vertebral body, adding complexity to repair.

  4. Acute vs. Chronic

    • Acute: Injury recognized and treated within days, often before scar tissue forms.

    • Chronic: Presentation weeks or months later, with stiff scar tissue and increased difficulty in reduction.

  5. Open vs. Locked Facets

    • Locked: Facet surfaces fully perched over one another, resisting closed (non-surgical) reduction.

    • Open: Facet surfaces partially disengaged and may be reduced more easily.


Causes

  1. Motor Vehicle Collisions
    A sudden deceleration in a car crash can hyperflex and distract the lumbar spine, tearing facet ligaments and causing complete bilateral dislocation.

  2. High-Speed Motorcycle Accidents
    Ejection or abrupt stops impart extreme forces to the lower back, overwhelming facet joint restraints and leading to dislocation.

  3. Falls from Height
    Landing on the feet or buttocks from a significant height transmits axial load and flexion to the lumbar spine, risking ligamentous failure.

  4. Sports Trauma
    High-impact sports (e.g., skiing, rugby) can deliver forces that hyperextend or hyperflex the lumbar spine, rupturing facet capsules.

  5. Industrial Accidents
    Crushing injuries or falls in construction settings may apply bending and shear to the lumbar region, dislocating facets.

  6. Seatbelt-Related Injuries
    In older cars without proper restraints, a lap belt alone can act as a fulcrum, bending the spine around it and tearing facet ligaments.

  7. Osteoporosis
    Weakened bone may fracture around the facet joints under lower forces, predisposing to dislocation even in moderate trauma.

  8. Rheumatoid Arthritis
    Chronic inflammation can erode facet capsules and ligaments, reducing stability and allowing dislocation under minor stresses.

  9. Ankylosing Spondylitis
    Excessive rigidity from spinal fusion chips away at normal flexibility, so when failure occurs it often involves complete dislocation.

  10. Congenital Facet Malformation
    Abnormally shaped or oriented facets can reduce joint congruity, making dislocation easier when stressed.

  11. Degenerative Facet Arthropathy
    Wear-and-tear changes erode cartilage and ligaments, progressively destabilizing the joint until full dislocation is possible.

  12. Spondylolisthesis Progression
    Existing slippage from a pars defect (spondylolysis) can worsen under stress, culminating in complete bilateral facet dislocation.

  13. Spinal Infections
    Osteomyelitis or septic arthritis in the facet joints weakens structural integrity, risking dislocation under normal loads.

  14. Metastatic Lesions
    Cancer deposits in the vertebrae or facet reduce bone strength; minimal force can then trigger a dislocation.

  15. Iatrogenic Causes
    Previous spinal surgery that removes stabilizing structures (e.g., laminectomy) may predispose to facet failure later.

  16. Calcific Tendinitis of Ligaments
    Calcium deposits stiffen ligamentous structures; they lose elasticity, then snap under sudden load.

  17. Connective Tissue Disorders
    Marfan or Ehlers-Danlos syndromes can involve hyperlax ligaments, allowing abnormal spinal motion and dislocation.

  18. Childhood Trauma
    Unrecognized pediatric spinal injuries can weaken facet support, leading to adult dislocation under moderate trauma.

  19. Repetitive Microtrauma
    Repeated minor injuries in heavy laborers can accumulate damage to facet capsules, eventually causing a full dislocation.

  20. Violent Assault
    Blunt force to the low back (e.g., beating, kicking) can instantly shear the lumbar facets out of place.


Symptoms

  1. Severe Low Back Pain
    Usually immediate and intense, localized at the injury level, worsened by movement.

  2. Radicular Leg Pain
    Sharp, shooting pain radiating down one or both legs when nerve roots are irritated.

  3. Numbness or Tingling
    Sensory loss or “pins and needles” in the buttocks, thighs, or lower legs.

  4. Muscle Weakness
    Difficulty lifting the foot (foot drop) or reduced thigh/buttock strength from nerve compression.

  5. Difficulty Walking
    Gait becomes unsteady or antalgic due to pain and weakness.

  6. Paralysis Below Level
    In severe cases, inability to move the legs indicates serious neurological compromise.

  7. Loss of Reflexes
    Diminished knee or ankle reflexes on exam due to nerve root injury.

  8. Bladder Retention
    Inability to urinate from conus or cauda equina compression.

  9. Bowel Incontinence
    Loss of bowel control when lower sacral nerves are affected.

  10. Perianal Numbness
    “Saddle anesthesia” in the groin or inner thighs, a red-flag sign for cauda equina syndrome.

  11. Spasm of Paraspinal Muscles
    Involuntary tightening of the back muscles around the injured level.

  12. Visible Deformity
    A subtle step-off or abnormal contour of the lumbar spine may be palpable.

  13. Limited Range of Motion
    Marked difficulty bending forward, backward, or rotating due to instability.

  14. Pain on Palpation
    Tenderness when pressing directly over the affected facet joints.

  15. Pain with Extension
    Standing up straight or leaning backward sharply increases discomfort.

  16. Pain with Flexion
    Bending forward or sitting can also aggravate the disrupted facets.

  17. Postural Changes
    A stooped or tilted posture as the patient tries to avoid painful movements.

  18. Autonomic Changes
    Sweating or flushing below the injury level from sympathetic nerve involvement.

  19. Anxiety and Distress
    Severe trauma can provoke acute stress responses and fear of moving.

  20. Sleep Disturbance
    Pain worsens at night, making it hard to find a comfortable position.


Diagnostic Tests

Physical Examination

  1. Observation of Posture
    Look for abnormal tilt or step-off at the lumbar spine when standing.

  2. Palpation
    Gentle pressing over each lumbar facet to locate points of maximal tenderness.

  3. Range-of-Motion Assessment
    Measure flexion, extension, lateral bending, and rotation, noting pain-limited arcs.

  4. Straight Leg Raise
    Passive lifting of the relaxed leg to provoke sciatic pain, suggesting nerve root irritation.

  5. Modified Schober’s Test
    Marks on the back to quantify lumbar flexion shortening when bending forward.

  6. Gait Analysis
    Watch for limping, antalgic gait, or foot drop during walking.

  7. Neurological Exam
    Test muscle strength (MRC scale), sensation (light touch, pinprick), and reflexes (knee, ankle).

  8. Provocative Maneuvers
    Extension-Rotation test (pain on putting weight through one side in extension) to stress facets.

Manual Tests

  1. Passive Intersegmental Motion
    Stabilizing one vertebra and moving the one above to assess abnormal laxity or locking.

  2. Facet Joint Compression
    Gentle downward force on the transverse processes to reproduce facet pain.

  3. Spring Test
    Anterior or posterior gliding of spinous processes to detect excessive translation.

  4. Stork Test
    Standing on one leg and extending backwards to isolate one facet, noting pain reproduction.

  5. Prone Segmental Instability Test
    Patient prone, lift legs off table; pain that eases when legs are lifted indicates instability.

  6. Long‐Sit Test
    Transition from lying to sitting to detect a shift in limb length, signifying pelvic rotation from spinal injury.

  7. Kemps Test
    While standing, rotation and extension toward one side to stress ipsilateral facets.

  8. Quadrant Test
    Similar to Kemp’s but with added lateral flexion to further provoke facet pain.

Lab & Pathological Tests

  1. Complete Blood Count (CBC)
    Checks for elevated white cells that might suggest infection weakening structures.

  2. Erythrocyte Sedimentation Rate (ESR)
    High levels point to inflammation or infection affecting the spine.

  3. C-Reactive Protein (CRP)
    A sensitive marker for acute inflammation, useful in ruling out septic causes.

  4. Rheumatoid Factor (RF)
    Helps detect rheumatoid arthritis involvement in facet degeneration.

  5. HLA-B27 Testing
    Positive in ankylosing spondylitis, which can predispose to facet dislocations.

  6. Serum Calcium & Vitamin D
    Low levels indicate osteoporosis risk, making fracture‐dislocations more likely.

  7. Tumor Markers
    CEA, PSA, or CA-19-9 may hint at metastatic disease causing pathological dislocation.

  8. Blood Culture
    If infection is suspected, cultures can identify the pathogen in septic facet arthritis.

Electrodiagnostic Tests

  1. Nerve Conduction Studies (NCS)
    Measures speed of electrical signals in peripheral nerves; slowed conduction suggests nerve root injury.

  2. Electromyography (EMG)
    Assesses muscle electrical activity; spontaneous activity indicates denervation from root compression.

  3. Somatosensory Evoked Potentials (SSEPs)
    Stimulates peripheral nerves and records brain responses to assess spinal cord pathway integrity.

  4. Motor Evoked Potentials (MEPs)
    Transcranial stimulation to evaluate motor tract function through the spinal cord.

  5. F-Wave Studies
    Late responses in NCS that can reveal proximal nerve root dysfunction.

  6. H-Reflex Testing
    Assesses S1 nerve root integrity by stimulating the tibial nerve and recording soleus muscle response.

  7. Paraspinal Mapping
    Multiple-needle EMG in the paraspinal muscles to localize the segment of nerve injury.

  8. Blink Reflex
    Though cranial, can sometimes reveal widespread demyelination in systemic disorders affecting stability.

Imaging Tests

  1. Plain X-Rays (AP/Lateral)
    First-line; shows alignment, vertebral translation, and gross facet malalignment.

  2. Flexion-Extension X-Rays
    Dynamic views to confirm instability if initial films are inconclusive.

  3. Computed Tomography (CT)
    Detailed bone images reveal facet joint fractures, locked facets, and degree of displacement.

  4. Magnetic Resonance Imaging (MRI)
    Visualizes ligaments, disc, spinal cord, and nerve roots; essential for planning surgery.

  5. CT Myelogram
    CT after intrathecal contrast; useful when MRI contraindicated, shows nerve root impingement.

  6. Bone Scan
    Sensitive for infection or occult fractures not seen on CT, though less specific.

  7. Dual-Energy CT
    Can differentiate gouty deposits or calcifications in the facet region from other pathologies.

  8. Ultrasound-Guided Facet Injection
    Diagnostic local anesthetic injection under imaging can confirm the facet joint as the pain source

Non-Pharmacological Treatments

A. Physiotherapy and Electrotherapy Therapies

  1. Manual Mobilization
    A therapist uses their hands to gently move spinal joints, restoring alignment. Its purpose is to reduce stiffness and improve mobility by stretching tight ligaments. Gentle force encourages synovial fluid flow, nourishing cartilage and reducing pain.

  2. Spinal Manipulation
    Quick, targeted thrusts are applied to the vertebrae by a chiropractor. This relieves joint fixation and restores normal motion. The audible “crack” comes from gas release in the joint, easing pressure and reducing nerve irritation.

  3. Traction Therapy
    Patients lie on a table while a mechanical device applies a gentle pulling force on the lumbar spine. This creates space between vertebrae, reducing nerve compression and relieving disc pressure by elongating spinal ligaments.

  4. Interferential Current (IFC)
    Low-frequency electrical currents penetrate deep tissues to modulate pain. Electrodes placed on the skin deliver alternating currents that stimulate endorphin release, block pain signals, and increase local blood flow for healing.

  5. Transcutaneous Electrical Nerve Stimulation (TENS)
    Portable TENS units send mild electrical pulses through adhesive pads on the lower back. These pulses activate large-fiber nerves, “closing the gate” on pain signals at the spinal cord and triggering endorphin release for natural pain relief.

  6. Ultrasound Therapy
    High-frequency sound waves are applied via a wand to the lumbar region. The waves create tiny vibrations in tissues, promoting collagen production, reducing inflammation, and improving circulation to speed soft-tissue healing.

  7. Low-Level Laser Therapy (LLLT)
    Low-intensity laser beams penetrate the skin to stimulate cellular repair. Photons enhance mitochondrial function, boosting ATP production and reducing inflammation. The result is faster tissue regeneration and decreased pain.

  8. Hot Pack Application
    Moist heat is applied using electric hydrocollators. The warmth dilates blood vessels, increases oxygen delivery, and relaxes muscle spasms. Heat also improves tissue elasticity, making stretching and exercise more comfortable.

  9. Cold Pack Therapy
    Ice packs reduce inflammation and numb pain by constricting blood vessels. Cold slows nerve conduction, decreasing pain signal transmission. It’s most effective in the acute phase, within 48–72 hours post-injury.

  10. Contrast Baths
    Alternating warm and cold water baths for the lower back encourage vasodilation and vasoconstriction. This “pumps” fluid through tissues, reducing swelling and flushing out inflammatory chemicals.

  11. Therapeutic Ultrasound-Guided Dry Needling
    Fine needles target trigger points in paraspinal muscles under ultrasound guidance. The mechanical stimulation releases muscle tension and improves local blood flow, breaking the cycle of pain and spasm.

  12. Pulsed Electromagnetic Field Therapy (PEMF)
    Low-frequency electromagnetic fields are applied to the lumbar area via a mat or pad. PEMF influences ion exchange in cell membranes, reducing inflammation and speeding bone and soft tissue repair.

  13. Microcurrent Therapy
    Very low electrical currents mimic the body’s own electrical signals, promoting cell repair. Microcurrents stimulate fibroblast activity, accelerating soft-tissue healing and reducing pain and swelling.

  14. Pressure Garments and Belts
    Elastic lumbar braces provide support and limit harmful movements while still allowing gentle motion. The compression reduces muscular fatigue and gives the wearer confidence to perform rehabilitation exercises.

  15. Soft Tissue Mobilization
    Hands-on techniques stretch and glide muscles and fascia around the spine. By breaking down adhesions and improving tissue glide, this method decreases pain and restores functional movement.

B. Exercise Therapies

  1. Core Stabilization Exercises
    Gentle isometric contractions of the deep abdominal and back muscles train the “corset” of your spine. A stronger core reduces load on the injured facets, stabilizes the vertebrae, and prevents further displacement.

  2. Pelvic Tilt Exercises
    While lying on your back, you flatten and arch your lower back by tilting the pelvis. This movement gently mobilizes lumbar segments, improves awareness of spinal positioning, and relieves tight lower back muscles.

  3. Bird-Dog Exercise
    On hands and knees, you extend one arm and the opposite leg, holding for several seconds. This challenges core stability and trains coordination, enhancing spinal support and reducing abnormal loading on facets.

  4. Bridging
    Lying on your back with knees bent, you lift hips off the floor, engaging glutes and hamstrings. Bridges strengthen the posterior chain, redistributing forces away from the injured joints and improving overall pelvic alignment.

  5. Knee-to-Chest Stretch
    Pulling one knee at a time toward the chest stretches the lower back and gluteal muscles. Gentle elongation of lumbar soft tissues reduces muscle tension, improves flexibility, and eases facet pressure.

  6. Hip Flexor Stretch
    In a lunge position, you stretch the front of the hip. Tight hip flexors can tilt the pelvis forward, increasing lumbar lordosis and facet stress. Stretching restores neutral pelvic position, reducing joint load.

  7. Wall Squats
    With your back against a wall, you slide down into a squat. Wall squats train leg and core muscles without excessive spine bending. Strong legs share load with the spine, preventing overuse of the injured facets.

C. Mind-Body Therapies

  1. Mindful Breathing
    Slow, focused breathing techniques calm the nervous system and reduce pain perception. Diaphragmatic breathing also relaxes paraspinal muscles, decreasing muscle tension around the injured facets.

  2. Guided Imagery
    Audio-recorded or therapist-led visualization of healing in the lumbar region shifts attention away from pain. By engaging the brain’s relaxation response, guided imagery lowers stress hormones and eases muscle tightness.

  3. Progressive Muscle Relaxation
    Sequentially tensing and relaxing different muscle groups reduces overall body tension. As muscles release, blood flow improves and pain signals decrease, helping to break the cycle of pain and spasm.

  4. Yoga-Based Stretching
    Gentle yoga poses adapted for low back pain improve flexibility, balance, and core strength. Poses like “Cat-Cow” mobilize the spine, increase synovial fluid movement, and encourage mindfulness of posture.

  5. Tai Chi
    Slow, flowing movements coordinate posture, balance, and breath. Tai Chi strengthens core and lower limb muscles, improves proprioception, and reduces fall risk. The meditative aspect also lowers pain-related stress.

D. Educational Self-Management

  1. Pain Education Sessions
    Learning about pain mechanisms, coping strategies, and safe activity levels empowers patients. Understanding why movement is safe reduces fear-avoidance, enabling earlier return to daily activities and faster recovery.

  2. Ergonomic Counseling
    Therapists assess home and work setups, recommending adjustments like proper chair height and lifting techniques. Ergonomic changes reduce harmful spinal loading, protecting healing facets and preventing re-injury.

  3. Home Exercise Programs
    Personalized exercise plans with clear instructions and progress goals encourage adherence. Self-management of core and flexibility exercises ensures continued improvement and prevents recurrence of facet irritation.


Evidence-Based Drugs

Each drug listed below is commonly used to manage pain, inflammation, or muscle spasm in lumbar facet dislocation. Dosage refers to typical adult dosing; individual needs vary.

  1. Ibuprofen (NSAID)

    • Dosage: 400–800 mg orally every 6–8 hours

    • Timing: With meals to reduce stomach upset

    • Side Effects: Gastric irritation, kidney stress, elevated blood pressure

  2. Naproxen (NSAID)

    • Dosage: 250–500 mg orally twice daily

    • Timing: Morning and evening, with food

    • Side Effects: Dyspepsia, fluid retention, heartburn

  3. Diclofenac (NSAID)

    • Dosage: 50 mg orally three times daily or 75 mg extended-release once daily

    • Timing: With food

    • Side Effects: Liver enzyme elevations, gastrointestinal bleeding risk

  4. Celecoxib (COX-2 Inhibitor)

    • Dosage: 100–200 mg orally once or twice daily

    • Timing: Irrespective of meals

    • Side Effects: Cardiovascular risk, diarrhea, edema

  5. Ketorolac (NSAID, short-term)

    • Dosage: 10 mg orally every 4–6 hours (max 40 mg/day)

    • Timing: Only up to 5 days

    • Side Effects: Ulcers, renal impairment, bleeding

  6. Acetaminophen (Analgesic)

    • Dosage: 500–1000 mg orally every 6 hours (max 3000 mg/day)

    • Timing: Around the clock for continuous pain relief

    • Side Effects: Liver toxicity in overdose

  7. Prednisone (Oral Steroid)

    • Dosage: 5–10 mg daily for short courses

    • Timing: Morning to mimic natural cortisol rhythms

    • Side Effects: Weight gain, mood swings, glucose intolerance

  8. Methylprednisolone (Oral Steroid Burst)

    • Dosage: 4 mg tablets tapering schedule over 6 days

    • Timing: Morning dose higher, taper lower in afternoon

    • Side Effects: Insomnia, fluid retention, increased appetite

  9. Cyclobenzaprine (Muscle Relaxant)

    • Dosage: 5–10 mg orally three times daily

    • Timing: At bedtime reduces daytime drowsiness

    • Side Effects: Dry mouth, drowsiness, dizziness

  10. Methocarbamol (Muscle Relaxant)

    • Dosage: 1500 mg orally four times daily

    • Timing: With meals to avoid gastrointestinal upset

    • Side Effects: Lightheadedness, sedation

  11. Tizanidine (Alpha-2 Agonist)

    • Dosage: 2–4 mg orally every 6–8 hours (max 36 mg/day)

    • Timing: Adjust around patient tolerance

    • Side Effects: Hypotension, dry mouth, weakness

  12. Gabapentin (Neuropathic Pain)

    • Dosage: 300 mg at night, titrate to 900–1800 mg/day in divided doses

    • Timing: Evening start reduces daytime sedation

    • Side Effects: Dizziness, fatigue, peripheral edema

  13. Pregabalin (Neuropathic Pain)

    • Dosage: 75 mg twice daily (max 300 mg/day)

    • Timing: Twice daily, with or without food

    • Side Effects: Weight gain, somnolence, dry mouth

  14. Duloxetine (SNRI for Chronic Pain)

    • Dosage: 30 mg daily, may increase to 60 mg

    • Timing: With food to reduce nausea

    • Side Effects: Nausea, insomnia, sweating

  15. Amitriptyline (Tricyclic Antidepressant)

    • Dosage: 10–25 mg at bedtime

    • Timing: Nighttime to take advantage of sedation

    • Side Effects: Dry mouth, constipation, orthostatic hypotension

  16. Ketamine Infusion (Severe Refractory Pain)

    • Dosage: 0.1–0.3 mg/kg/hr intravenous infusion over several hours

    • Timing: In monitored hospital setting

    • Side Effects: Hallucinations, elevated blood pressure

  17. Lidocaine Patch (Topical Analgesic)

    • Dosage: One 5% patch applied over painful area for 12 hours on, 12 hours off

    • Timing: Can be used daily for weeks

    • Side Effects: Local skin irritation

  18. Capsaicin Cream (Topical)

    • Dosage: 0.025–0.075% cream applied three to four times daily

    • Timing: Avoid open wounds

    • Side Effects: Burning sensation on application

  19. Clonidine Patch (Adjunct Analgesic)

    • Dosage: 0.1 mg/24 hr patch, may increase to 0.3 mg/24 hr

    • Timing: Change weekly

    • Side Effects: Hypotension, sedation

  20. Oxycodone/Acetaminophen (Opioid Combination)

    • Dosage: 5/325 mg every 6 hours as needed (use sparingly)

    • Timing: Only for severe breakthrough pain

    • Side Effects: Constipation, drowsiness, dependence


Dietary Molecular Supplements

These supplements may support bone, cartilage, and nerve health.

  1. Glucosamine Sulfate

    • Dosage: 1500 mg daily

    • Function: Provides building blocks for cartilage repair

    • Mechanism: Stimulates chondrocyte activity, reduces cartilage breakdown

  2. Chondroitin Sulfate

    • Dosage: 1200 mg daily

    • Function: Maintains joint fluid viscosity

    • Mechanism: Inhibits enzymes that degrade cartilage matrix

  3. Methylsulfonylmethane (MSM)

    • Dosage: 1000–2000 mg daily

    • Function: Reduces inflammation and oxidative stress

    • Mechanism: Donates sulfur for connective tissue synthesis

  4. Collagen Peptides

    • Dosage: 10 g daily

    • Function: Supports ligament and tendon health

    • Mechanism: Supplies amino acids for extracellular matrix

  5. Vitamin D3

    • Dosage: 1000–2000 IU daily

    • Function: Enhances calcium absorption for bone strength

    • Mechanism: Upregulates calcium transport proteins in intestine

  6. Calcium Citrate

    • Dosage: 500 mg twice daily

    • Function: Fundamental mineral for bone density

    • Mechanism: Direct substrate for hydroxyapatite formation

  7. Magnesium Glycinate

    • Dosage: 200–400 mg daily

    • Function: Aids muscle relaxation and nerve function

    • Mechanism: Cofactor for ATPases, stabilizes nerve membranes

  8. Omega-3 Fatty Acids

    • Dosage: 1000 mg EPA/DHA daily

    • Function: Anti-inflammatory for joints and nerves

    • Mechanism: Competes with arachidonic acid to reduce proinflammatory eicosanoids

  9. Turmeric (Curcumin)

    • Dosage: 500 mg standardized extract twice daily

    • Function: Natural anti-inflammatory

    • Mechanism: Inhibits NF-κB and COX-2 pathways

  10. Boswellia Serrata Extract

    • Dosage: 300 mg three times daily

    • Function: Reduces joint inflammation

    • Mechanism: Inhibits 5-lipoxygenase, lowering leukotriene synthesis


Advanced Drug Therapies

Targeted at bone health, regeneration, and pain relief:

  1. Alendronate (Bisphosphonate)

    • Dosage: 70 mg once weekly

    • Function: Inhibits bone resorption

    • Mechanism: Binds hydroxyapatite, induces osteoclast apoptosis

  2. Zoledronic Acid (Bisphosphonate)

    • Dosage: 5 mg intravenous once yearly

    • Function: Potent antiresorptive for osteoporosis

    • Mechanism: Disrupts osteoclast cytoskeleton, blocking bone breakdown

  3. Platelet-Rich Plasma (Regenerative)

    • Dosage: 3–5 mL injected at injury site

    • Function: Delivers growth factors for healing

    • Mechanism: Concentrated platelets release PDGF, TGF-β to stimulate cell proliferation

  4. Hyaluronic Acid Injection (Viscosupplementation)

    • Dosage: 2 mL injected into facet joint every month for 3 months

    • Function: Lubricates joint, reduces friction

    • Mechanism: Increases synovial fluid viscosity, protecting cartilage

  5. Bone Morphogenetic Protein-2 (Regenerative)

    • Dosage: Used during spinal fusion surgery as a collagen sponge implant

    • Function: Promotes new bone formation

    • Mechanism: Activates osteoprogenitor cells to differentiate into osteoblasts

  6. Stem Cell Therapy (Mesenchymal Stem Cells)

    • Dosage: 1–5 million cells injected percutaneously into facet region

    • Function: Regenerates cartilage and soft tissues

    • Mechanism: MSCs differentiate into chondrocytes and secrete trophic factors

  7. Hyaluronic Acid Oral Supplementation

    • Dosage: 200 mg daily

    • Function: Supports joint lubrication from within

    • Mechanism: Absorbed hyaluronan precursors incorporate into synovial fluid

  8. Calcitonin Nasal Spray

    • Dosage: 200 IU daily

    • Function: Mild analgesic and antiresorptive

    • Mechanism: Inhibits osteoclast activity, modulates pain perception

  9. Teriparatide (Recombinant PTH)

    • Dosage: 20 mcg subcutaneously daily

    • Function: Stimulates new bone formation

    • Mechanism: Anabolic effect on osteoblasts, increasing bone mass

  10. CTX-Corneal-Derived Protein (Experimental Regenerative)

    • Dosage: Under clinical trial—injectable implant into joint capsule

    • Function: Encourages cartilage matrix production

    • Mechanism: Activates resident chondrocytes and stem cells


Surgical Procedures

Surgery is reserved for severe cases with instability or neurological compromise.

  1. Posterior Lumbar Fusion

    • Procedure: Screws and rods fix two vertebrae, bone graft added

    • Benefits: Stabilizes spine, prevents further dislocation, relieves pain

  2. Transforaminal Lumbar Interbody Fusion (TLIF)

    • Procedure: Facet joint removed, interbody cage placed between vertebrae

    • Benefits: Restores disc height, decompresses nerves, achieves solid fusion

  3. Anterior Lumbar Interbody Fusion (ALIF)

    • Procedure: Surgeon approaches from abdomen, places cage and graft

    • Benefits: Larger graft surface, better lordosis restoration, less muscle disruption

  4. Posterior Lumbar Interbody Fusion (PLIF)

    • Procedure: Midline back incision, bilateral cages inserted, pedicle screws placed

    • Benefits: Direct decompression of nerve roots, stable fusion

  5. Facet Joint Excision and Debridement

    • Procedure: Damaged facet surfaces removed and smoothed

    • Benefits: Reduces mechanical irritation and local inflammation

  6. Laminectomy with Fusion

    • Procedure: Removal of the lamina to decompress nerves, followed by fusion

    • Benefits: Immediate nerve relief and long-term stability

  7. Minimally Invasive Transfacet Screw Fixation

    • Procedure: Percutaneous screws placed through facets under imaging guidance

    • Benefits: Less muscle injury, faster recovery, shorter hospital stay

  8. Dynamic Stabilization (Facet Joint Spacer)

    • Procedure: Implant inserted between dislocated facets to maintain motion

    • Benefits: Preserves some spinal mobility, reduces adjacent segment stress

  9. Posterolateral Fusion

    • Procedure: Bone graft placed between transverse processes, secured with rods

    • Benefits: Effective stabilization, avoids interbody work

  10. Vertebral Column Resection

    • Procedure: Removal of one or more vertebral bodies in extreme deformity

    • Benefits: Corrects severe malalignment, decompresses spinal cord


Prevention Strategies

Protect your spine before injury or re-injury:

  1. Maintain a strong core with regular exercise

  2. Practice safe lifting techniques: bend knees, keep back straight

  3. Use ergonomic chairs and lumbar support when sitting

  4. Avoid prolonged static postures—take movement breaks every 30 minutes

  5. Wear properly fitted footwear to maintain good posture

  6. Keep a healthy weight to reduce spinal load

  7. Warm up before sports or heavy activity

  8. Avoid high-impact activities if you have known facet weakness

  9. Stay hydrated for optimal disc health

  10. Quit smoking to improve bone and soft tissue healing


When to See a Doctor

If you experience any of the following after trauma or worsening back pain, seek medical care immediately:

  • Sudden weakness or numbness in legs

  • Loss of bladder or bowel control

  • Severe, unrelenting low back pain that limits movement

  • High fever or signs of infection with back pain

  • Pain following a high-impact accident


“Do’s and Don’ts”

What to Do

  1. Do keep moving with gentle stretches every day.

  2. Do apply heat or cold based on your phase of healing.

  3. Do follow your home exercise program consistently.

  4. Do use a lumbar brace if advised by your therapist.

  5. Do sleep on a firm mattress with proper pillow support.

  6. Do stay hydrated to maintain disc health.

  7. Do take medications exactly as prescribed.

  8. Do practice good posture when standing or sitting.

  9. Do gradually progress activity, listening to your body.

  10. Do report new or worsening symptoms to your provider.

What to Avoid

  1. Don’t bend and twist together when lifting.

  2. Don’t sit or stand in one position for too long.

  3. Don’t lift heavy objects without assistance.

  4. Don’t ignore sharp nerve pain or tingling.

  5. Don’t play high-impact sports until cleared.

  6. Don’t sleep on overly soft surfaces.

  7. Don’t rely solely on painkillers without therapy.

  8. Don’t resume heavy work without professional guidance.

  9. Don’t smoke or use tobacco products.

  10. Don’t skip follow-up appointments.


Frequently Asked Questions

  1. What exactly causes a bilateral complete facet dislocation?
    High-energy trauma—like a car crash or major fall—forces one vertebra forward on another, tearing ligaments and pushing both facet joints completely out of alignment.

  2. Is surgery always required?
    Not always. Mild dislocations with no nerve injury may be managed conservatively. However, most complete dislocations need surgical stabilization to prevent permanent nerve damage.

  3. How long does recovery take?
    With surgery, bone fusion and soft-tissue healing usually take 3–6 months. Full functional recovery can take up to a year with dedicated rehabilitation.

  4. Will I have chronic pain afterward?
    Many patients achieve significant pain relief, but some may have lingering discomfort. A comprehensive rehab plan reduces the risk of chronic pain.

  5. Can I return to work?
    Light desk work may resume in 6–12 weeks. Heavy labor or sports often require clearance at 6–12 months, depending on healing and strength.

  6. What are the risks of steroid injections?
    Rarely, infections or nerve injury can occur. Steroids can also weaken nearby tissues if overused, so injections are limited to a few per year.

  7. Are opioids necessary?
    Opioids are reserved for severe pain not controlled by other drugs. Short courses under strict supervision minimize dependence risk.

  8. Can physical therapy alone fix it?
    In stable, partial dislocations with minimal nerve involvement, a structured therapy program can restore function. Complete dislocations usually need surgery plus therapy.

  9. What role do supplements play?
    Supplements like glucosamine and vitamin D support joint and bone health but cannot replace medical or surgical treatment. They serve as adjunctive support.

  10. Is stem cell therapy proven?
    Early studies show promise for tissue regeneration, but stem cell treatments are still experimental and not standard of care.

  11. How do I prevent re-injury?
    Follow ergonomic guidelines, maintain core strength, and avoid risky activities. A gradual return-to-activity program supervised by a therapist is essential.

  12. What if I feel tingling or weakness?
    Immediately contact your doctor. These signs suggest nerve compression, which may require urgent intervention to prevent permanent damage.

  13. Can braces cure the dislocation?
    Braces provide temporary support and pain relief but do not realign bones. Only reduction maneuvers or surgery can properly reposition facets.

  14. Are there long-term lifestyle changes needed?
    Yes. Ongoing core exercises, posture awareness, and weight management help protect your spine for life.

  15. When should I seek a second opinion?
    If your pain worsens despite treatment, if you have persistent neurological signs, or if surgery risks are high, a second opinion ensures the best care plan.

Disclaimer: Each person’s journey is unique, treatment plan, life style, food habit, hormonal condition, immune system, chronic disease condition, geological location, weather and previous medical  history is also unique. So always seek the best advice from a qualified medical professional or health care provider before trying any treatments to ensure to find out the best plan for you. This guide is for general information and educational purposes only. Regular check-ups and awareness can help to manage and prevent complications associated with these diseases conditions. If you or someone are suffering from this disease condition bookmark this website or share with someone who might find it useful! Boost your knowledge and stay ahead in your health journey. We always try to ensure that the content is regularly updated to reflect the latest medical research and treatment options. Thank you for giving your valuable time to read the article.

The article is written by Team RxHarun and reviewed by the Rx Editorial Board Members

Last Updated: June 19, 2025.

PDF Document For This Disease Conditions

References

To Get Daily Health Newsletter

We don’t spam! Read our privacy policy for more info.

Download Mobile Apps
Follow us on Social Media
© 2012 - 2025; All rights reserved by authors. Powered by Mediarx International LTD, a subsidiary company of Rx Foundation.
RxHarun
Logo