Thoracic Bilateral Perched Facet Dislocation

Thoracic bilateral perched facet dislocation is a rare but serious spinal injury in which the inferior articular processes of two adjacent thoracic vertebrae are forced “perched” upon the superior articular processes of the vertebra below on both sides, without fully locking into complete dislocation. Unlike a locked facet—where the articular surfaces fully disengage and overlap—perched facets represent a subtotal displacement, leaving the joint surfaces partially engaged. This injury most often occurs at the junction between the rigid, rib-anchored thoracic spine and the more mobile lumbar segments (typically around T10–T12), where biomechanical forces concentrate during high-energy trauma radiopaedia.orgmdpi.com.

Because the thoracic spine has a relatively narrow canal and is stabilized by ribs and costotransverse joints, bilateral perched facet dislocations here carry a very high risk of spinal cord injury and neurological impairment. Prompt recognition and management are critical to prevent secondary cord damage from movement of the perched facets.

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Types of Facet Joint Injury

Facet joint injuries range from mild capsular tears to severe dislocations. They are classified as follows:

1. Joint Capsule Injury
   A mild sprain of the facet-joint capsule, leading to minor widening (<2 mm) of the joint space without displacement faculty.washington.edu.

2. Subluxed Facet Joint
   Partial uncovering of the facet surfaces due to ligamentous injury, but without the articular processes becoming perched radiopaedia.org.

3. Perched Facets (Subtotal Dislocation)
   The inferior articular process sits “perched” on the superior process below, representing a subtotal displacement. When this occurs on both sides, it is termed bilateral perched facet dislocation radiopaedia.org.

4. Locked Facets (Complete Dislocation)
   The facet surfaces fully disengage and overlap, often requiring surgical reduction. Locked facets have the highest instability faculty.washington.edu.

5. Unilateral vs. Bilateral

   • Unilateral involves one side, often seen with rotational injuries.

   • Bilateral involves both sides, typically associated with flexion-distraction mechanisms. Bilateral perched facets fall under flexion-distraction injuries and correspond to AO Spine Type C (translational) injuries radiopaedia.orgmdpi.com.

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Causes

Thoracic bilateral perched facet dislocations are overwhelmingly traumatic, but a few non-traumatic factors may predispose the spine to injury:

1. High-Speed Motor Vehicle Collisions
   Sudden deceleration and hyperflexion forces concentrate at the thoracolumbar junction, prying the facets apart mdpi.com.

2. Falls from Height
   Landing on the feet or buttocks drives axial loads through the spine, leading to flexion-distraction injuries mdpi.com.

3. Sports Injuries (e.g., Snowboarding, Moto-Cross)
   High-velocity impacts or awkward landings can hyperflex the thoracic spine and distract the posterior elements.

4. Diving Accidents
   Head-first impact into shallow water causes abrupt flexion and axial compression.

5. Industrial Crush Injuries
   Heavy objects falling onto the upper back can forcibly distract the facets.

6. Assault (Blunt Trauma)
   Direct blows to the back in assaults can create distraction and hyperflexion.

7. Penetrating Trauma
   Rarely, missile or stab wounds disrupt supporting ligaments, allowing facetal displacement.

8. Osteoporosis
   Weakened vertebral bodies and facet capsules may give way under minor trauma, leading to spontaneous perched dislocation.

9. Rheumatoid Arthritis
   Chronic synovial inflammation can erode facet capsules, predisposing to instability even with low-energy forces.

10. Ankylosing Spondylitis
    Auto-fusion of spinal segments transfers stress to adjacent joints, which may fail under minimal trauma.

11. Ehlers-Danlos Syndrome
    Congenital collagen defects cause ligamentous laxity, increasing risk of facet subluxation and perch.

12. Pathologic Fractures (Tumor-Related)
    Metastatic lesions destroy vertebral and facet integrity, allowing displacement.

13. Osteomyelitis (Spinal Infection)
    Bone erosion from infection undermines facet stability, possibly resulting in an atraumatic perched dislocation.

14. Iatrogenic (Post-Surgical)
    Over-resection of facets during decompression surgery can leave the joint unstable.

15. Degenerative Spondylolisthesis
    Chronic disc and facet degeneration may progress to perched displacement under rotational loading.

16. Metabolic Bone Disease (Osteomalacia)
    Softened bones from vitamin D deficiency may buckle under normal loads.

17. Corticosteroid Therapy
    Long-term steroids accelerate osteoporosis, indirectly weakening facets.

18. Congenital Facet Dysplasia
    Malformed facets provide poor articulation, predisposing to partial displacement.

19. Post-Radiation Changes
    Radiation-induced osteonecrosis can erode facet support.

20. Segmental Kyphotic Deformities
    Abnormal kyphosis increases tension on posterior elements, making perched dislocation more likely under flexion.

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Symptoms

Patients with thoracic bilateral perched facet dislocation may present with:

1. Acute Severe Back Pain
   Immediate, intense pain at the injury level, worsened by movement.

2. Visible Kyphotic Deformity
   A focal outward bend may be seen or palpated at the segment.

3. Muscle Spasm
   Reflex paraspinal contraction guarding the injured area.

4. Tenderness to Palpation
   Localized pain on light pressure over the spinous processes.

5. Limited Range of Motion
   Particularly in flexion and extension of the thoracic spine.

6. Step-Off Sign
   A palpable step between adjacent spinous processes.

7. Radicular Pain
   Pain radiating along the intercostal nerves around the ribs.

8. Hypesthesia
   Reduced sensation in dermatomes corresponding to the injured level.

9. Motor Weakness
   Weakness in the lower extremities if the cord is compromised.

10. Hyperreflexia
    Exaggerated deep tendon reflexes below the lesion indicates upper motor neuron involvement.

11. Clonus
    Involuntary muscle contractions signifying cord irritation.

12. Bowel/Bladder Dysfunction
    Urinary retention or incontinence with significant cord compression.

13. Numbness or Paresthesia
    Tingling or “pins and needles” in the chest or legs.

14. Spinal Shock
    Flaccid paralysis and areflexia below the injury in the acute phase.

15. Respiratory Difficulty
    Upper thoracic injuries (above T6) may impair intercostal muscle function.

16. Autonomic Dysreflexia
    In chronic cases, uncontrolled hypertension and sweating above the lesion.

17. Gait Disturbance
    Ataxic or spastic gait if cord involvement is partial.

18. Sensory Level
    A clear cutoff in sensation on the torso corresponding to the nervous level.

19. Pain with Valsalva
    Exacerbation of back pain during coughing or bearing down.

20. Bruising or Swelling
    Soft-tissue changes may accompany severe trauma.

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Diagnostic Tests

Physical Examination

1. Inspection
   Look for asymmetry, deformity, swelling, or bruising.

2. Palpation
   Assess point tenderness along spinous processes and facets.

3. Range of Motion Testing
   Gently test flexion, extension, lateral bending, and rotation—pain or restriction is a red flag.

4. Step-Off Sign
   Palpable misalignment between adjacent spinous processes.

5. Muscle Spasm Assessment
   Evaluate paraspinal muscle tightness guarding the injury.

6. Sensory Examination
   Test light touch and pinprick in key dermatomes.

7. Motor Strength Testing
   Grade muscle groups (e.g., hip flexors, knee extensors) to detect weakness.

8. Reflex Testing
   Check deep tendon reflexes (patellar, Achilles) for hyperreflexia or asymmetry.

Manual Provocative Tests

9. Kemp’s Test
   Extension-rotation of the spine with axial load to provoke facet pain.

10. Valsalva Maneuver
    Increased intrathecal pressure reproducing pain with cough or straining.

11. Extension-Rotation Test
    Combining hyperextension with rotation to stress the facet joints.

12. Distraction Test
    Gentle upward traction to relieve facet pain, confirming facetogenic origin.

13. Segmental Spring Test
    Posterior-to-anterior pressure on the spinous process to assess segmental mobility.

14. Passive Intervertebral Motion (PIVM)
    Therapist-controlled small oscillatory movements to localize the painful level.

15. Compression Test
    Lateral bending with downward pressure to narrow the facet bilaterally.

16. Stork Test
    Single-leg stance with hyperextension to detect unilateral facet stress (bilateral stress when both sides).

Laboratory & Pathological Tests

17. Complete Blood Count (CBC)
    To rule out infection (elevated WBC) or anemia predisposing to falls pmc.ncbi.nlm.nih.gov.

18. Erythrocyte Sedimentation Rate (ESR)
    Elevated in infection or inflammatory arthropathies.

19. C-Reactive Protein (CRP)
    Acute-phase reactant, high in infection or systemic inflammation.

20. Blood Cultures
    If spinal infection is suspected.

21. Basic Metabolic Panel
    Assesses electrolytes and renal function prior to contrast imaging.

22. Serum Calcium & Vitamin D
    Low levels suggest metabolic bone disease.

23. Parathyroid Hormone (PTH)
    Elevated in primary hyperparathyroidism weakening bone.

24. Alkaline Phosphatase
    Marker of bone turnover—high in Paget’s disease or metastasis.

Electrodiagnostic Tests

25. Electromyography (EMG)
    Detects denervation patterns in paraspinal or lower-limb muscles.

26. Nerve Conduction Study (NCS)
    Assesses conduction velocity in peripheral nerves.

27. Somatosensory Evoked Potentials (SSEPs)
    Evaluates dorsal column integrity.

28. Motor Evoked Potentials (MEPs)
    Tests corticospinal tract function.

29. F-Wave Studies
    Provides information on proximal nerve segments.

30. H-Reflex
    Assesses S1 nerve root and reflex arc.

31. Dynamic Neuromonitoring
    Intraoperative EMG/SSEP monitoring during reduction.

32. Quantitative Sensory Testing
    Measures threshold of vibration or thermal sensation.

Imaging Tests

33. Plain Radiography (AP & Lateral)
    First-line, shows sagittal translation or perched facets.

34. Flexion-Extension X-Rays
    Dynamic views to reveal occult instability orthobullets.com.

35. Computed Tomography (CT)
    Gold standard for bony detail and facet alignment sciencedirect.com.

36. CT Myelogram
    Useful when MRI is contraindicated, delineates canal compromise.

37. Magnetic Resonance Imaging (MRI)
    Visualizes cord edema, ligamentous injury, and disc herniation pmc.ncbi.nlm.nih.gov.

38. MRI with STIR Sequences
    Highlights soft-tissue and ligamentous edema.

39. Bone Scintigraphy
    Detects occult fractures or stress reactions.

40. Positron Emission Tomography (PET-CT)
    Reserved for pathologic cases when neoplasia or infection is suspected.

Non-Pharmacological Treatments

A. Physiotherapy & Electrotherapy Therapies

1. Transcutaneous Electrical Nerve Stimulation (TENS)
   TENS delivers low-voltage electrical currents through skin electrodes near the injury site. Its purpose is to block pain signals traveling to the brain and release natural endorphins. Mechanistically, it stimulates large nerve fibers that inhibit nociceptive (pain) pathways in the spinal cord.

2. Therapeutic Ultrasound
   Ultrasound uses high-frequency sound waves to warm deep tissues. It aims to increase local blood flow, reduce muscle spasm, and accelerate healing. Mechanically, the sound waves cause microscopic vibrations that produce heat and stimulate cellular repair processes.

3. Interferential Current Therapy
   Two medium-frequency currents intersect at the injury site, creating a low-frequency stimulation deep in tissues. It relieves pain and edema by improving circulation and interfering with pain transmission.

4. Short-Wave Diathermy
   This modality emits high-frequency electromagnetic waves to heat deep tissues. Its goal is to reduce muscle stiffness and spasm while improving flexibility. Heat generated at the cellular level increases tissue extensibility and metabolic activity.

5. Ice (Cryotherapy)
   Applying ice packs immediately after injury constricts blood vessels to minimize swelling and pain. The cold slows nerve conduction velocity and decreases inflammatory mediator release.

6. Heat Therapy (Moist Heat Packs)
   Moist heat increases circulation to relaxed muscles and ligaments around the injured facets. Heat promotes oxygen and nutrient delivery, easing stiffness.

7. Manual Joint Mobilization
   A trained therapist uses skilled, rhythmic movements to move arthritic or stiff facet joints. Mobilization aims to restore normal joint play and alignment by stretching the joint capsule and supporting ligaments.

8. Soft-Tissue Massage
   Adult hands knead and stroke muscles around the spine to reduce guarding and knotting. The mechanical pressure breaks down adhesions, relaxes muscles, and boosts blood flow.

9. Myofascial Release
   Sustained pressure on tight fascia (connective tissue) helps lengthen and rehydrate the layers around muscles. This reduces pain by normalizing tissue tension and improving sliding between muscle bundles.

10. Spinal Traction (Mechanical)
    A traction table gently pulls the torso, creating space between vertebrae to relieve compression on facets and nerve roots. It reduces pain by unloading the joint and promoting fluid exchange in discs.

11. Spinal Traction (Manual)
    The therapist applies controlled, hands-on traction to the patient’s shoulders or pelvis. It achieves the same decompressive effect as mechanical traction, with the therapist adjusting pressure in real time.

12. Electro-Acupuncture
    Thin needles are placed near injured facets and stimulated with a mild electric current. This combines acupuncture’s gate-control effects with electrical stimulation to modulate pain pathways.

13. Low-Level Laser Therapy (LLLT)
    Low-intensity lasers target injured tissues to reduce inflammation and stimulate cellular repair. Photons penetrate skin and trigger mitochondrial activity, boosting energy production in cells.

14. Neuromuscular Electrical Stimulation (NMES)
    Electrodes placed on paraspinal muscles deliver currents to elicit muscle contractions. NMES strengthens weakened muscles, promoting better spinal support and posture.

15. Continuous Passive Motion (CPM) Device
    A motorized unit slowly moves the thoracic spine through a controlled range, preventing joint stiffness and adhesions. It enhances synovial fluid circulation and maintains mobility in the injured segment.

B. Exercise Therapies

16. Isometric Core Stabilization
    Patients gently contract deep spinal stabilizers (transversus abdominis, multifidus) without movement. Holding each contraction for 10–15 seconds improves joint support and decreases shear forces on facets.

17. Prone Extension Exercises
    Lying face down, patients lift chest slightly off the table while keeping hips grounded. This promotes extension at the thoracic facets, reducing buckled posture and retraining normal alignment.

18. Quadruped Arm/Leg Raises (“Bird Dog”)
    On hands and knees, patients extend opposite arm and leg simultaneously. This dynamic stability exercise challenges the thoracolumbar fascia and trains co-contraction of extensors.

19. Thoracic Mobility on Foam Roller
    Lying sideways on a foam roller under the upper back, patients rotate their arms over head. This mobilizes mid-back segments, breaking up stiffness around the dislocated facets.

20. Resistance Band Rows
    Seated or standing, pulling a resistance band toward the torso strengthens rhomboids and mid-trapezius. Stronger upper-back muscles off-load strained facets and improve posture.

C. Mind-Body Therapies

21. Guided Imagery
    Patients visualize healing energy around their spine to reduce pain perception. This engages the brain’s descending inhibitory pathways, lowering pain through cognitive modulation.

22. Mindful Breathing
    Slow, deep breaths focus attention away from pain and lower sympathetic arousal. Reduced stress hormones and muscle tension help control spasm around injured facets.

23. Progressive Muscle Relaxation
    Sequentially tensing and releasing muscle groups from toes to head releases total-body tension. Muscle relaxation decreases pressure on facet joints and improves comfort.

24. Yoga (Modified Thoracic Poses)
    Gentle chest-opening and side-bending postures, adapted to avoid extreme flexion or rotation, enhance spine mobility and mind-body awareness. Enhanced proprioception helps avoid harmful movements.

25. Tai Chi
    Slow, flowing movements train core control and spinal alignment. The coordinated weight shifts relieve stress on facets and improve overall balance, reducing fall risk.

D. Educational Self-Management Strategies

26. Posture Education
    Learning neutral spine alignment when standing, sitting, or lifting reduces abnormal facet loading. Awareness of ergonomics prevents positions that could worsen the perched dislocation.

27. Activity Pacing
    Breaking tasks into shorter intervals with rest prevents overloading healing tissues. Pacing maintains function without triggering pain spikes around the injured facets.

28. Back‐School Programs
    Structured classes teach anatomy, safe lifting, and pain-coping skills. Education empowers patients to manage symptoms and avoid harmful movements.

29. Pain Tracking Diary
    Recording pain levels, activities, and triggers helps identify patterns. Adjusting routines based on diary insights minimizes harmful behaviors.

30. Ergonomic Home Modifications
    Simple adjustments—like raising chair height or using supportive pillows—optimize daily posture. This self-management approach stabilizes the spine and reduces undue facet stress.

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Pharmacological Treatments

Below are 20 evidence-based drugs commonly used to manage pain, inflammation, muscle spasm, and nerve irritation in thoracic facet dislocations. Each entry notes the drug class, typical adult dosage, timing relative to meals or activities, and key side effects to monitor.

1. Ibuprofen (NSAID)

   • Dosage: 400–600 mg orally every 6–8 hours as needed

   • Timing: With food to lower upset stomach risk

   • Side Effects: Gastric irritation, kidney stress, increased bleeding risk

2. Naproxen (NSAID)

   • Dosage: 250–500 mg twice daily

   • Timing: With breakfast and dinner

   • Side Effects: Heartburn, edema, dizziness

3. Diclofenac (NSAID)

   • Dosage: 50 mg three times daily

   • Timing: With meals

   • Side Effects: Liver enzyme elevation, hypertension

4. Celecoxib (COX-2 Inhibitor)

   • Dosage: 100–200 mg once or twice daily

   • Timing: With or without food

   • Side Effects: Increased cardiovascular risk, renal impairment

5. Acetaminophen (Analgesic)

   • Dosage: 500–1000 mg every 6 hours (max 4 g/day)

   • Timing: Spaced evenly

   • Side Effects: Liver toxicity if overdosed

6. Carisoprodol (Muscle Relaxant)

   • Dosage: 250–350 mg three times daily and at bedtime

   • Timing: Short-term use only (≤2–3 weeks)

   • Side Effects: Drowsiness, dizziness, risk of dependence

7. Cyclobenzaprine (Muscle Relaxant)

   • Dosage: 5–10 mg three times daily

   • Timing: At consistent intervals

   • Side Effects: Dry mouth, sedation, blurred vision

8. Tizanidine (Alpha-2 Agonist)

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

   • Timing: Watch for hypotension; take at same times daily

   • Side Effects: Low blood pressure, weakness, dry mouth

9. Gabapentin (Neuropathic Pain Agent)

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

   • Timing: Slowly taper up over days

   • Side Effects: Somnolence, peripheral edema

10. Pregabalin (Neuropathic Pain Agent)

    • Dosage: 75 mg twice daily, titrate to 300 mg/day

    • Timing: Morning and evening

    • Side Effects: Weight gain, dizziness

11. Duloxetine (SNRI Antidepressant)

    • Dosage: 30 mg once daily, increase to 60 mg/day if needed

    • Timing: With food

    • Side Effects: Nausea, dry mouth, insomnia

12. Amitriptyline (Tricyclic Antidepressant)

    • Dosage: 10–25 mg at bedtime

    • Timing: At night to reduce daytime drowsiness

    • Side Effects: Constipation, urinary retention, sedation

13. Ketorolac (Potent NSAID, short-term)

    • Dosage: 10 mg orally every 6 hours (max 5 days)

    • Timing: Strictly short course due to bleeding risk

    • Side Effects: GI bleeding, kidney injury

14. Morphine (Opioid Analgesic)

    • Dosage: 5–10 mg orally every 4 hours as needed

    • Timing: Only when severe pain is unrelieved by NSAIDs/acetaminophen

    • Side Effects: Constipation, respiratory depression, dependence

15. Oxycodone/Acetaminophen (Combination Opioid)

    • Dosage: 5 mg/325 mg every 4–6 hours as needed

    • Timing: For breakthrough pain

    • Side Effects: Same as morphine plus acetaminophen toxicity risk

16. Dexketoprofen (NSAID)

    • Dosage: 25 mg every 8 hours

    • Timing: With meals

    • Side Effects: GI discomfort, headache

17. Etoricoxib (COX-2 Inhibitor)

    • Dosage: 90 mg once daily

    • Timing: With or without food

    • Side Effects: Hypertension, edema, cardiovascular risk

18. Methocarbamol (Muscle Relaxant)

    • Dosage: 1,500 mg four times daily on first day, then 750 mg four times daily

    • Timing: Short-term use

    • Side Effects: Sedation, dizziness

19. Capsaicin Topical Cream

    • Dosage: Apply pea-sized amount 3–4 times daily

    • Timing: Clean skin before use

    • Side Effects: Burning sensation at application site

20. Lidocaine 5% Patch

    • Dosage: Up to three patches for 12 hours on, 12 hours off

    • Timing: Local nerve block

    • Side Effects: Local skin irritation

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Dietary Molecular Supplements

These supplements support bone health, reduce inflammation, and aid tissue repair. Each is backed by at least preliminary clinical evidence.

1. Vitamin D₃ (Cholecalciferol)

   • Dosage: 1,000–2,000 IU daily

   • Function: Enhances calcium absorption for bone strength

   • Mechanism: Binds vitamin D receptors in intestines to upregulate calcium‐transport proteins

2. Calcium Citrate

   • Dosage: 500 mg twice daily

   • Function: Primary mineral for bone matrix

   • Mechanism: Supplies elemental calcium to osteoblasts for bone deposition

3. Omega-3 Fatty Acids (EPA/DHA)

   • Dosage: 1,000 mg fish oil daily

   • Function: Reduces inflammation in injured tissues

   • Mechanism: Competes with arachidonic acid to produce less-inflammatory eicosanoids

4. Collagen Peptides

   • Dosage: 10 g daily

   • Function: Provides amino acids for ligament and tendon repair

   • Mechanism: Stimulates fibroblast activity and extracellular matrix synthesis

5. Turmeric Extract (Curcumin)

   • Dosage: 500 mg twice daily

   • Function: Anti-inflammatory and antioxidant

   • Mechanism: Inhibits NF-κB signaling and COX-2 enzyme activity

6. Boswellia Serrata (Frankincense)

   • Dosage: 300 mg three times daily

   • Function: Reduces joint inflammation

   • Mechanism: Blocks 5-lipoxygenase pathway, lowering leukotriene formation

7. Methylsulfonylmethane (MSM)

   • Dosage: 1,000 mg twice daily

   • Function: Supports connective tissue integrity

   • Mechanism: Donates sulfur for glycosaminoglycan synthesis in cartilage

8. Vitamin C (Ascorbic Acid)

   • Dosage: 500 mg daily

   • Function: Essential cofactor for collagen formation

   • Mechanism: Activates prolyl and lysyl hydroxylase enzymes in collagen crosslinking

9. Magnesium Citrate

   • Dosage: 250 mg daily

   • Function: Muscle relaxation and nerve function

   • Mechanism: Modulates calcium channels and regulates neurotransmitter release

10. Zinc Picolinate

    • Dosage: 15 mg daily

    • Function: Supports tissue repair and immune response

    • Mechanism: Cofactor for metalloproteinases involved in extracellular matrix remodeling

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Advanced Pharmacological Agents

These specialized therapies target bone density, joint lubrication, and regenerative healing.

1. Alendronate (Bisphosphonate)

   • Dosage: 70 mg once weekly

   • Function: Inhibits bone resorption

   • Mechanism: Binds to hydroxyapatite and induces osteoclast apoptosis

2. Zoledronic Acid (Bisphosphonate)

   • Dosage: 5 mg IV annually

   • Function: Potent anti-resorptive for osteoporosis prevention

   • Mechanism: Disrupts osteoclast cytoskeleton and function

3. Teriparatide (Recombinant PTH)

   • Dosage: 20 mcg subcutaneously daily

   • Function: Stimulates new bone formation

   • Mechanism: Activates osteoblast lineage and increases bone mass

4. Hyaluronic Acid Injection (Viscosupplementation)

   • Dosage: 1–2 mL into facet joint under imaging guidance, once monthly × 3

   • Function: Improves joint lubrication and shock absorption

   • Mechanism: Restores synovial fluid viscosity and protects cartilage

5. Platelet-Rich Plasma (PRP) Injection

   • Dosage: 3–5 mL into the facet joint, 1–3 injections at 2-week intervals

   • Function: Delivers growth factors to accelerate healing

   • Mechanism: Concentrated platelets release PDGF, TGF-β, and VEGF to recruit reparative cells

6. Mesenchymal Stem Cell Injection

   • Dosage: 1–2 million cells into the joint capsule

   • Function: Regenerates cartilage and ligament tissue

   • Mechanism: Differentiates into chondrocytes and releases cytokines that modulate inflammation

7. Bone Morphogenetic Protein-2 (BMP-2)

   • Dosage: 1.5 mg on collagen sponge at fusion site (surgical use)

   • Function: Enhances spinal fusion

   • Mechanism: Potent osteoinductive growth factor stimulating osteoblast differentiation

8. Calcitonin (Nasal Spray)

   • Dosage: 200 IU daily

   • Function: Reduces bone breakdown and provides analgesia

   • Mechanism: Inhibits osteoclast activity and modulates central pain pathways

9. Autologous Conditioned Serum

   • Dosage: 2–4 mL facet injection weekly for 3 weeks

   • Function: Lowers inflammatory cytokines in joints

   • Mechanism: Upregulates IL-1 receptor antagonist in synovial fluid

10. Stem-Cell-Derived Exosomes

    • Dosage: Experimental; 100–200 µg protein per injection

    • Function: Paracrine support for tissue regeneration

    • Mechanism: Exosomes deliver microRNAs and growth factors to injured cells

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Surgical Procedures

When non-surgical measures fail or neurological signs worsen, these ten operations may be indicated. Each procedure aims to realign and stabilize the thoracic spine.

1. Closed Reduction under Anesthesia
   The patient is gently manipulated under muscle relaxation to guide perched facets back into place. This minimally invasive step avoids open surgery if done promptly.

2. Open Posterior Facet Dislocation Reduction
   Via a midline back incision, the surgeon exposes the dislocated facets, manually repositions them, and checks realignment under X-ray. Offers direct control over reduction.

3. Posterior Instrumentation and Fusion
   Titanium rods and pedicle screws are placed above and below the injury, then linked to maintain stability. Bone graft is packed to achieve permanent fusion. This prevents re-dislocation.

4. Laminectomy with Facetectomy
   In cases with severe canal compromise, the lamina and part of the facet are removed to decompress the spinal cord. This relieves pressure but may require fusion for stability.

5. Anterior Thoracic Fusion (Transthoracic Approach)
   Through a chest incision, the surgeon removes damaged disc and facets, places a cage with bone graft, and fixes a plate for fusion. Allows direct visualization of the front of the spine.

6. Costotransversectomy
   Part of the rib and transverse process is removed to access and decompress nerve roots and reduce the dislocation. Preserves posterior tension band integrity better than full facetectomy.

7. Vertebral Column Resection
   In severe, multi-level injuries, the entire vertebral body is removed and replaced with a custom cage. Provides maximal realignment but is highly invasive.

8. Minimally Invasive Pedicle Screw Fixation
   Using small incisions and fluoroscopy, screws are placed with percutaneous techniques, reducing muscle damage and blood loss. Offers faster recovery.

9. Robotic-Assisted Spinal Fusion
   Robotic arms guide optimal screw placement and alignment. Enhances precision and reduces radiation exposure.

10. Endoscopic Facet Joint Injection & Debridement
    Under endoscope guidance, the damaged facet capsule is cleaned, and local bone debris removed. A small amount of bone graft is placed to support fusion biologically.

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Prevention Strategies

1. Wear Proper Seatbelts and Airbags
   Always buckle up in vehicles to distribute crash forces and reduce hyperflexion of the thoracic spine.

2. Use Fall-Prevention Measures at Home
   Install grab bars and remove loose rugs. Safe walking surfaces cut risk of high-energy falls.

3. Practice Safe Lifting Techniques
   Bend at hips and knees (not the back), keep loads close, and avoid twisting while lifting.

4. Maintain Strong Core Muscles
   Regular core exercises support spinal alignment and reduce strain on facet joints.

5. Stay at a Healthy Weight
   Excess body weight increases compressive forces on spinal joints during daily activities.

6. Use Ergonomic Furniture
   Chairs with lumbar support and adjustable height reduce abnormal postures that stress facets.

7. Wear Protective Gear in Sports
   Back braces and padding in contact sports lower risk of spine trauma.

8. Quit Tobacco
   Smoking impairs bone healing and reduces disc health, making the spine more vulnerable.

9. Get Regular Bone Density Screenings
   Early detection of osteoporosis allows treatment to prevent fragility fractures that can lead to facet injuries.

10. Attend Driver Safety Courses
    Improved driving habits and hazard avoidance reduce car-crash risks.

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When to See a Doctor

• Sudden, Severe Back Pain not relieved by rest or over-the-counter painkillers

• Numbness, Tingling, or Weakness in the legs or torso

• Loss of Bladder or Bowel Control (possible spinal cord compression)

• Deformity or “Step-Off” in mid-back alignment

• High-Energy Trauma (e.g., fall >10 ft, high-speed crash) even if pain seems mild

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“Do’s and Don’ts”

Do

1. Rest briefly, then gradually reintroduce light movement under guidance.

2. Use ice and heat alternately to control swelling and muscle tension.

3. Sleep on a firm mattress with a small pillow under the knees.

4. Wear a supportive brace if prescribed by your therapist.

5. Follow your exercise-program daily to rebuild strength and stability.

Don’t

1. Bend or twist forcefully—avoid heavy lifting for at least 6–8 weeks.

2. Sit in slouched positions for long periods.

3. Ignore warning signs of nerve compression (numbness, weakness).

4. Self-adjust or crack your back forcefully without professional help.

5. Return to high-impact sports until cleared by your surgeon or therapist.

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Frequently Asked Questions

1. How long does recovery take?
   Most people need 3–6 months of therapy and gradual return to activity. Fusion surgeries may require up to a year for complete bone healing.

2. Can I avoid surgery?
   If there is no neurological deficit and alignment can be restored by closed reduction, non-surgical care may suffice. Otherwise, fusion often offers best long-term stability.

3. Will I ever lift heavy objects again?
   With proper fusion or healed ligaments, many patients can return to moderate lifting—typically under 20 kg—with safe body mechanics.

4. Is walking good for recovery?
   Yes—regular, gentle walking promotes circulation, reduces stiffness, and helps control pain.

5. Can this injury cause chronic pain?
   If facet joints remain unstable or develop arthritis, chronic pain can occur. Early therapy and stabilization reduce that risk.

6. Is driving safe after this injury?
   You may resume driving when you can sit upright without bracing yourself, typically 4–6 weeks after injury or fusion.

7. Do I need a back brace?
   A brace can help reduce motion and pain during the initial 6–12 weeks, but should be weaned off to allow muscle strengthening.

8. Can I take over-the-counter supplements?
   Yes—calcium, vitamin D, and omega-3s support healing, but discuss dosages with your doctor to avoid interactions.

9. When can I return to work?
   Light desk work may be possible in 4–6 weeks; manual labor often requires 3–6 months, depending on healing and job demands.

10. What complications should I watch for?
    Worsening pain, fever, numbness, bowel/bladder changes, or pus at wound sites after surgery—all need urgent evaluation.

11. Is smoking a problem?
    Yes—smoking delays bone and soft-tissue healing. Quitting improves outcomes after both non-surgical and surgical care.

12. Can physical therapy make things worse?
    When guided by a trained therapist, exercises are tailored to avoid harmful motions. Unsupervised or overly aggressive therapy can aggravate pain.

13. What role does nutrition play?
    Adequate protein, vitamins, and minerals fuel tissue repair. Poor diet delays healing and increases infection risks post-surgery.

14. Will I need pain medication long-term?
    Most patients taper off strong pain drugs within 2–3 months. Non-opioid options and non-drug therapies manage residual discomfort.

15. Is stem-cell therapy proven?
    Early studies show promise for regeneration of facet cartilage, but long-term data are limited. It remains considered experimental in many centers.

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.

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