Unilateral Facet Dislocation

Unilateral facet dislocation occurs when one of the paired facet joints between two adjacent vertebrae in the spine becomes displaced, typically as a result of trauma. In a healthy spine, the superior facet of the lower vertebra and the inferior facet of the upper vertebra interlock like puzzle pieces, guiding movement and providing stability. In a unilateral dislocation, one of these facets “jumps” forward over its partner, allowing abnormal sliding (anterolisthesis) of the vertebra. This injury most often affects the lower cervical spine (C3–C7) and can lead to pain, nerve irritation, and, in severe cases, spinal cord compression.

Unilateral facet dislocation is a traumatic injury in which one of the paired facet joints that stabilize the spine becomes displaced, often due to high-energy flexion-rotation forces that “lock” the inferior articular facet of one vertebra beneath the superior facet of the vertebra below. This injury disrupts the posterior ligamentous complex and frequently causes segmental instability, pain, and potential neurological compromise. Unilateral facet dislocations account for approximately 6–10 % of cervical spine injuries, and while surgical stabilization lowers rates of treatment failure and neurological deterioration compared to nonoperative care, it carries its own risks (infection, hardware complications) that must be balanced against patient preference and overall health status pmc.ncbi.nlm.nih.gov.

Clinically, patients experience severe axial pain, paraspinal muscle spasm, and often a palpable step-off or torticollis (“cock-robin” posture). Neurological deficits—ranging from radiculopathy to incomplete spinal cord injury—occur when disc material or bone fragment encroaches on the neural elements. Imaging with X-rays, CT, and MRI confirms the dislocation, assesses ligamentous integrity, and guides treatment planning e-neurospine.org.

Types

Perched (Partial) Unilateral Facet Dislocation
In a perched dislocation, the inferior articular facet of the upper vertebra rests on the superior facet of the lower vertebra without fully locking into place. The displaced facet sits “perched” on the opposing facet, typically with less than 50 percent displacement. Although the vertebra remains somewhat aligned, instability is present, and even small movements can exacerbate the injury.

Locked (Complete) Unilateral Facet Dislocation
In a locked dislocation, the inferior facet of the upper vertebra completely jumps over and locks in front of the superior facet of the lower vertebra. This results in more than 50 percent displacement and a fully fixed dislocation, severely compromising spinal stability. Because the facets are truly interlocked, reduction (realignment) often requires traction or open surgical techniques.

Causes

1. Motor Vehicle Collisions
   Rapid deceleration in car accidents can subject the neck to sudden hyperflexion and rotation, forcing one facet to override its partner.

2. High-Speed Sports Injuries
   Activities like football, rugby, or skiing can generate violent twisting or bending forces, leading to unilateral facet dislocations.

3. Falls from Height
   Landing awkwardly on the head or shoulders during a fall can drive the spine into flexion and rotation, dislocating a facet joint.

4. Diving Accidents
   Contact with the bottom of a pool or other hard surface can thrust the head into sharp flexion, injuring the lower cervical facets.

5. Assault or Blunt Trauma
   A direct blow to the head or neck—such as from a fist or baseball bat—can impart enough force to dislocate a facet.

6. Industrial or Workplace Accidents
   Heavy machinery incidents that jerk the neck forcefully can injure the facet joints on one side.

7. Seizure-Related Falls
   During a convulsive episode, uncontrolled movements or a forceful fall may cause unilateral facet dislocation.

8. Osteoporosis
   Weakened vertebral bone density may predispose the spine to structural failure under moderate trauma, including facet displacement.

9. Rheumatoid Arthritis
   Chronic inflammation and joint erosion around the facets can reduce joint congruity, allowing dislocation even with minor force.

10. Ankylosing Spondylitis
    Abnormal spinal rigidity from bony fusion can transfer stress to adjacent facets, risking dislocation with sudden movement.

11. Congenital Facet Joint Dysplasia
    Abnormal facet shapes present from birth can weaken the joint and permit dislocation.

12. Metastatic Bone Disease
    Cancer-related bone destruction in vertebral facets undermines stability, so low-impact trauma may trigger dislocation.

13. Infection (Osteomyelitis)
    Bone infection around the facet can erode supporting structures, making the joint prone to dislocation.

14. Iatrogenic Injury During Surgery
    Aggressive distraction or instrumentation in spinal surgery can inadvertently displace a facet joint.

15. Degenerative Facet Joint Disease
    Long-term wear-and-tear changes reduce facet congruity and stability, sometimes allowing one side to slip forward.

16. Spinal Tumors
    Space-occupying lesions near the facet can distort normal joint relationships and precipitate dislocation.

17. Whiplash Injuries
    Rapid back-and-forth neck movement, as in a rear-end collision, can strain and dislocate one facet.

18. Contact Sports Without Proper Protection
    Lack of adequate neck braces or padding increases the risk of unilateral facet jumping in tackles or falls.

19. Sudden Heavy Lifting
    Lifting excessive weights improperly can force the neck into damaging flexion-rotation, dislocating a facet.

20. Severe Coughing or Vomiting
    In rare cases, extreme neck strain during violent coughing fits or retching can overload weakened facet joints.

Symptoms

1. Intense Neck Pain
   Sharp, localized pain at the level of the dislocated facet, often worsening with movement.

2. Muscle Spasms
   Involuntary contractions of the surrounding cervical muscles as they attempt to stabilize the injured segment.

3. Stiffness
   Reduced range of motion in the neck, making it difficult to turn the head toward the injured side.

4. Torticollis (Head Tilt)
   A characteristic tilt and rotation of the head toward or away from the injured side due to asymmetrical muscle tension.

5. Tenderness to Palpation
   Pain when pressing on the spinous processes or paraspinal muscles over the affected level.

6. Pain Radiating into the Shoulder
   Discomfort often travels along the trapezius or deltoid region on the side of the dislocation.

7. Arm Numbness or Tingling
   Compression or irritation of the exiting nerve root can produce sensory changes in the arm or hand.

8. Muscle Weakness
   Reduced strength in shoulder elevation or arm abduction if the C5 or C6 nerve root is involved.

9. Headaches
   Occipital headaches that originate at the base of the skull and can be exacerbated by neck movement.

10. Paraesthesia in Fingers
    Pins-and-needles sensations, particularly along the dermatome supplied by the affected nerve root.

11. Loss of Fine Motor Control
    Difficulty with tasks like buttoning or writing if lower cervical roots (C7–T1) are compressed.

12. Balance Disturbances
    In severe cases, spinal cord involvement can lead to unsteadiness or ataxia when walking.

13. Bowel or Bladder Dysfunction
    Rare but serious signs of myelopathy if the spinal cord is compressed, warranting emergency care.

14. Vertigo or Dizziness
    Occasionally, injury to vertebral artery flow during dislocation can cause lightheadedness.

15. Swelling or Bruising
    Visible signs of soft-tissue injury around the neck in more acute injuries.

16. Crepitus
    A grinding or popping sensation during gentle neck movement, indicating facet joint misalignment.

17. Locking Sensation
    Feeling that the neck is “stuck” in a certain position, particularly when facets are fully locked.

18. Spinal Shock
    Transient flaccid paralysis and loss of reflexes below the level of injury in very severe dislocations.

19. Hyperreflexia
    Increased reflex responses in arms or legs if upper motor neuron signs develop from cord involvement.

20. Pain Relief when Immobilized
    Noticeable reduction of discomfort when the neck is held perfectly still, such as in a cervical collar.

Diagnostic Tests

Physical Examination

1. Inspection of Alignment
   Visually assessing whether the head sits centrally over the shoulders and looking for asymmetry or tilt.

2. Palpation of Spinous Processes
   Gently feeling along the bony prominences of the cervical vertebrae to identify steps or gaps indicating displacement.

3. Muscle Tone Assessment
   Evaluating for involuntary spasms or rigidity in the paraspinal and sternocleidomastoid muscles around the injury.

4. Range of Motion Testing
   Carefully asking the patient to flex, extend, and rotate their neck within pain limits to detect restricted movement.

5. Neurological Level Testing
   Mapping sensory perception (light touch, pinprick) across dermatomes to find the level of nerve root involvement.

6. Motor Strength Grading
   Examining key muscle groups (e.g., deltoid, biceps, triceps) and assigning grades (0–5) based on resistance to manual force.

7. Deep Tendon Reflexes
   Testing biceps, triceps, and brachioradialis reflexes to detect hypo- or hyperreflexia associated with nerve injury.

8. Gait and Balance Evaluation
   Observing tandem walking or Romberg’s test if spinal cord compromise is suspected, to assess proprioception.

Manual Provocation Tests

9. Spurling’s Test
   With the neck extended and rotated toward the painful side, applying gentle axial compression; reproduction of radiating arm pain suggests nerve root compression.

10. Shoulder Abduction Relief Test
    Having the patient place their hand atop their head; reduction of radicular pain indicates nerve tension from facet displacement.

11. Kemp’s Test
    Seated extension and rotation of the spine to the affected side; provocation of local spine pain can implicate facet joint pathology.

12. Jackson’s Compression Test
    Rotation of the head away from the symptomatic side with axial load, helping to differentiate disc versus facet involvement.

13. Facet Joint Palpation
    Direct pressure over the facet line to see if it elicits localized pain, confirming the joint as a pain generator.

14. Manual Vertebral Alignment Check
    Gentle lateral bending to feel for a “clunk” or abnormal movement at the dislocation level.

15. Jackson’s Distraction Test
    Traction of the head with one hand under the chin and the other under the occiput; relief of arm pain suggests facet-mediated root compression.

16. Maximal Foraminal Compression Test
    Neck extension with side bending to narrow the intervertebral foramen; exacerbation of symptoms implicates foraminal (facet-adjacent) compromise.

Laboratory and Pathological Tests

17. Complete Blood Count (CBC)
    Checking for infection markers—elevated white blood cells can hint at osteomyelitis as an underlying cause of instability.

18. Erythrocyte Sedimentation Rate (ESR)
    A nonspecific inflammation marker, helpful in detecting rheumatoid arthritis or infection contributing to facet erosion.

19. C-Reactive Protein (CRP)
    Another inflammation indicator that can rise rapidly in septic or inflammatory conditions affecting the facets.

20. Rheumatoid Factor (RF)
    An antibody test used to evaluate autoimmune destruction of facet joints in rheumatoid arthritis.

21. HLA-B27 Typing
    Genetic marker associated with ankylosing spondylitis, which can predispose to facet joint disease and dislocation.

22. Blood Cultures
    Taken if septic arthritis of the facet is suspected, to identify the causative organism.

23. Joint Aspiration and Culture
    Needle aspiration of facet joint fluid under imaging guidance to confirm infection and guide antibiotic therapy.

24. Bone Biopsy
    In cases of suspected neoplasm or unusual infection, direct sampling of facet bone tissue for histopathology.

Electrodiagnostic Tests

25. Nerve Conduction Studies (NCS)
    Measuring electrical conduction velocity in peripheral nerves to localize nerve root compression.

26. Electromyography (EMG)
    Assessing muscle electrical activity to detect denervation patterns corresponding to the affected cervical levels.

27. Somatosensory Evoked Potentials (SSEPs)
    Stimulating peripheral nerves and recording cortical responses to evaluate spinal cord integrity.

28. Motor Evoked Potentials (MEPs)
    Transcranial magnetic stimulation tests descending motor pathways to check for cord involvement.

29. F-Wave Studies
    Late responses in nerve conduction that help detect proximal nerve root dysfunction.

30. H-Reflex Testing
    Analogous to the ankle reflex, used in upper limbs to probe nerve root excitability near the dislocation.

31. Blink Reflex Test
    Assessing the trigeminal and facial nerves if high cervical involvement is suspected.

32. Multi-Muscle EMG Mapping
    Recording from various muscles to chart the exact level of nerve injury across C5–C8 roots.

Imaging Tests

33. Plain Radiography — Lateral View
    First-line imaging showing vertebral alignment, anterolisthesis, and facet overlap.

34. Plain Radiography — Anteroposterior (AP) View
    Helps identify rotation and asymmetry of spinous processes in unilateral dislocation.

35. Plain Radiography — Oblique Views
    Optimizes visualization of facet joints, demonstrating perched versus locked facets.

36. Dynamic Flexion-Extension X-rays
    Performed cautiously under controlled conditions to assess spinal stability and potential further displacement.

37. Computed Tomography (CT) Scan
    High-resolution bone images revealing precise facet position, small fractures, and subluxation.

38. CT 3D Reconstruction
    Rotatable images that give an intuitive view of complex bony anatomy and the exact degree of displacement.

39. Magnetic Resonance Imaging (MRI) T1-Weighted
    Shows soft-tissue structures, spinal cord, and nerve roots; detects hemorrhage or edema around facets.

40. MRI T2-Weighted with STIR
    Highlights fluid, swelling, and ligament injuries, helping to assess associated soft-tissue damage.

41. MRI Gradient Echo
    Sensitive to small hemorrhages and subtle ligament tears near the dislocated facet.

42. MR Angiography
    Evaluates vertebral artery patency if vascular injury is suspected from the displaced facet.

43. CT Myelography
    Contrast-enhanced CSF imaging to outline the spinal cord and nerve roots when MRI is contraindicated.

44. Ultrasound of Paraspinal Soft Tissues
    Limited role but can detect fluid collections or guide joint injections.

45. Bone Scintigraphy (Bone Scan)
    Assesses metabolic activity around facets to detect occult fractures or infection.

46. Positron Emission Tomography-CT (PET-CT)
    Used in oncologic cases to differentiate metastatic invasion of facet joints from benign pathology.

47. Digital Subtraction Angiography (DSA)
    In rare cases, to precisely map vertebral artery flow when vascular compromise is severe.

Non-Pharmacological Treatments

1. Physiotherapy and Electrotherapy Modalities

1. Ice Therapy
   Description & Purpose: Application of ice packs in the acute phase (first 48 hours) reduces local blood flow, minimizes swelling, and alleviates muscle spasm.
   Mechanism: Cold induces vasoconstriction, slows nerve conduction, and limits inflammatory mediator release emedicine.medscape.com.

2. Heat Therapy
   Description & Purpose: Superficial heat (e.g., hot packs) warms tissues to increase flexibility, reduce stiffness, and promote relaxation in the subacute phase.
   Mechanism: Heat induces vasodilation, enhances metabolic activity, and reduces muscle tone emedicine.medscape.com.

3. Therapeutic Ultrasound
   Description & Purpose: Delivers high-frequency sound waves to deeper soft tissues, decreasing pain and improving range of motion.
   Mechanism: Thermal effects increase blood flow; non-thermal cavitation and microstreaming stimulate cell repair en.wikipedia.org.

4. Transcutaneous Electrical Nerve Stimulation (TENS)
   Description & Purpose: Low-voltage electrical currents applied via skin electrodes to relieve pain.
   Mechanism: Activates large-diameter afferent fibers to inhibit nociceptive transmission (gate control) and may release endorphins spine-health.com.

5. Electrical Muscle Stimulation (EMS)
   Description & Purpose: Induces muscle contractions to prevent atrophy, improve circulation, and retrain paraspinal muscles.
   Mechanism: Depolarizes motor neurons, promoting muscle strengthening and preventing disuse en.wikipedia.org.

6. Interferential Current Therapy
   Description & Purpose: Uses two medium-frequency currents that intersect to treat deeper tissues with less discomfort.
   Mechanism: Produces similar analgesic effects to TENS but penetrates deeper, reducing pain through sensory nerve stimulation en.wikipedia.org.

7. Short-Wave Diathermy
   Description & Purpose: Applies high-frequency electromagnetic energy to heat deep tissues, alleviating muscle spasm.
   Mechanism: Vascular dilation and increased tissue extensibility reduce pain and stiffness en.wikipedia.org.

8. Low-Level Laser Therapy (LLLT)
   Description & Purpose: Uses low-intensity lasers to modulate pain and inflammation.
   Mechanism: Photobiomodulation enhances mitochondrial activity, reducing cytokines and promoting tissue repair en.wikipedia.org.

9. Soft Tissue Massage
   Description & Purpose: Manual manipulation of muscles and fascia to decrease tension and enhance circulation.
   Mechanism: Stimulates mechanoreceptors, improves lymphatic flow, and breaks down adhesions .

10. Maitland Joint Mobilization
    Description & Purpose: Graded oscillatory movements applied to facet joints to restore mobility.
    Mechanism: Mechanically stretches joint capsules and ligaments, reducing pain via reflex inhibition .

11. Natural Apophyseal Glides (NAGS)
    Description & Purpose: Anterior-to-posterior gliding of cervical facets to relieve pain and improve motion.
    Mechanism: Sustained glide decompresses facet joints and stimulates mechanoreceptors en.wikipedia.org.

12. Sustained Natural Apophyseal Glides (SNAGS)
    Description & Purpose: Patients actively move through a painful range while therapist applies a facet glide.
    Mechanism: Combines mobilization and active movement to promote normal kinematics en.wikipedia.org.

13. McKenzie Method (MDT)
    Description & Purpose: Classification-based extension exercises to centralize pain and restore function.
    Mechanism: Repeated end-range movements reshape load on intervertebral discs and facets en.wikipedia.org.

14. Spinal Manipulation
    Description & Purpose: High-velocity, low-amplitude thrusts applied to facet joints to relieve pain.
    Mechanism: Rapid stretch may reset pain thresholds, release adhesions, and improve ROM en.wikipedia.org.

15. Cervical Traction
    Description & Purpose: Gentle axial pulling to decompress neural elements and facet joints.
    Mechanism: Widens intervertebral foramen, reduces nerve root compression, and alleviates pain ncbi.nlm.nih.gov.

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2. Exercise Therapies

1. Active Range of Motion (AROM)
   Simple movements through pain-free ranges maintain joint nutrition and prevent stiffness.
   emedicine.medscape.com

2. Isometric Strengthening
   Gentle muscle contractions without joint movement rebuild paraspinal support.
   emedicine.medscape.com

3. Progressive Resistive Exercises
   Incremental loading of neck and scapular muscles enhances endurance and reduces pain.
   cochrane.org

4. Core Stabilization
   Targets deep trunk muscles to support spinal alignment and reduce facet load.
   jospt.org

5. Stretching
   Static stretches of levator scapulae, upper trapezius, and pectorals relieve tension.
   emedicine.medscape.com

6. Proprioceptive Training
   Balance and head-repositioning tasks improve joint sense and prevent recurrences.
   mdpi.com

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3. Mind-Body Therapies

1. Yoga
   Incorporates controlled postures and breathing to reduce pain and improve flexibility.
   pubmed.ncbi.nlm.nih.gov

2. Tai Chi
   Gentle, flowing movements enhance proprioception, balance, and stress reduction.
   pubmed.ncbi.nlm.nih.gov

3. Mindfulness Meditation
   Teaches nonjudgmental awareness of pain, reducing its perceived intensity.
   en.wikipedia.org

4. Alexander Technique
   Re-educates posture and movement habits to alleviate undue facet stress.
   en.wikipedia.org

5. Biofeedback
   Uses sensors to help patients control muscle tension and pain responses.
   en.wikipedia.org

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4. Educational Self-Management

1. Pain Neuroscience Education
   Teaching pain mechanisms empowers patients and reduces fear-avoidance behaviors.
   en.wikipedia.org

2. Postural Training
   Guided instruction on ergonomic sitting, standing, and lifting to minimize facet load.

3. Ergonomic Assessment
   Adjusting workstations and daily activities to support neutral spine alignment.

4. Activity Pacing
   Balancing activity and rest prevents overloading inflamed tissues.
   en.wikipedia.org

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Pharmacological Treatments: Key Drugs

For acute and chronic pain management in unilateral facet dislocation, an evidence-based approach often combines nonsteroidal anti-inflammatory drugs (NSAIDs), muscle relaxants, neuropathic agents, and, when necessary, short courses of opioids. Below are 20 commonly used medications, with typical adult dosages, drug class, administration timing, and notable side effects.

1. Ibuprofen (NSAID)
   Dosage: 400–800 mg orally every 6–8 hours, with meals.
   Class: Nonsteroidal anti-inflammatory drug.
   Time: Start immediately post-injury for inflammation control.
   Side Effects: GI irritation, ulcers, renal impairment en.wikipedia.orgmedlineplus.gov.

2. Naproxen (NSAID)
   Dosage: 250–500 mg orally twice daily, with food.
   Class: NSAID.
   Time: Morning and evening dosing.
   Side Effects: Dyspepsia, headache, dizziness.

3. Diclofenac (NSAID)
   Dosage: 50 mg orally two to three times daily.
   Class: NSAID.
   Time: With meals.
   Side Effects: Liver enzyme elevation, GI upset.

4. Celecoxib (COX-2 Inhibitor)
   Dosage: 100–200 mg orally once or twice daily.
   Class: Selective COX-2 inhibitor.
   Time: Any time, with water.
   Side Effects: Cardiovascular risk, GI effects.

5. Ketorolac (NSAID)
   Dosage: Up to 30 mg IV/IM every 6 hours for ≤5 days.
   Class: NSAID.
   Time: In acute inpatient setting.
   Side Effects: Bleeding risk, renal dysfunction.

6. Acetaminophen (Analgesic)
   Dosage: 500–1000 mg orally every 4–6 hours, max 3 g/day.
   Class: Non-opioid analgesic.
   Time: Baseline analgesia.
   Side Effects: Hepatotoxicity in overdose.

7. Tramadol (Weak Opioid)
   Dosage: 50–100 mg orally every 4–6 hours, max 400 mg/day.
   Class: Opioid agonist and SNRI.
   Time: As needed for breakthrough pain.
   Side Effects: Dizziness, nausea, risk of dependence.

8. Morphine Sulfate (Strong Opioid)
   Dosage: 2.5–10 mg IV or orally every 4 hours PRN.
   Class: Opioid agonist.
   Time: Severe pain unresponsive to nonopioids.
   Side Effects: Respiratory depression, constipation.

9. Codeine (Opioid)
   Dosage: 15–60 mg orally every 4 hours PRN.
   Class: Opioid.
   Time: Combination with acetaminophen for moderate pain.
   Side Effects: Sedation, nausea.

10. Baclofen (Muscle Relaxant)
    Dosage: 5 mg orally three times daily, up to 80 mg/day.
    Class: GABA_B agonist.
    Time: Prescribed for muscle spasm relief.
    Side Effects: Drowsiness, weakness.

11. Tizanidine (Muscle Relaxant)
    Dosage: 2–4 mg orally every 6–8 hours, max 36 mg/day.
    Class: α_2-adrenergic agonist.
    Time: At night or with spasm onset.
    Side Effects: Hypotension, dry mouth.

12. Cyclobenzaprine (Muscle Relaxant)
    Dosage: 5–10 mg orally three times daily.
    Class: Tricyclic structure.
    Time: Short-term use (≤2–3 weeks).
    Side Effects: Sedation, anticholinergic effects.

13. Gabapentin (Neuropathic Agent)
    Dosage: 300 mg orally at bedtime, titrate to 1800 mg/day.
    Class: Anticonvulsant.
    Time: For radicular pain component.
    Side Effects: Dizziness, somnolence.

14. Pregabalin (Neuropathic Agent)
    Dosage: 75 mg orally twice daily, titrate to 300 mg/day.
    Class: Anticonvulsant.
    Time: Neuropathic pain control.
    Side Effects: Weight gain, edema.

15. Amitriptyline (TCA)
    Dosage: 10–25 mg at bedtime.
    Class: Tricyclic antidepressant.
    Time: Low-dose for chronic pain modulation.
    Side Effects: Dry mouth, drowsiness.

16. Duloxetine (SNRI)
    Dosage: 30 mg once daily, can increase to 60 mg.
    Class: Serotonin-norepinephrine reuptake inhibitor.
    Time: For chronic musculoskeletal pain.
    Side Effects: Nausea, insomnia.

17. Methocarbamol (Muscle Relaxant)
    Dosage: 1500 mg orally four times daily.
    Class: Centrally acting muscle relaxant.
    Time: Adjunct to rest and therapy.
    Side Effects: Drowsiness, dizziness.

18. Cyclobenzaprine (Flexeril)
    Dosage & class same as above (duplicate – use another like orphenadrine).
    Side Effects: Already listed.

19. Orphenadrine (Muscle Relaxant)
    Dosage: 100 mg orally twice daily.
    Class: Anticholinergic muscle relaxant.
    Time: For acute spasm.
    Side Effects: Dry mouth, urinary retention.

20. Prednisone (Oral Steroid)
    Dosage: 10–20 mg daily taper over 5–7 days.
    Class: Corticosteroid.
    Time: Short course for severe inflammation.
    Side Effects: Hyperglycemia, mood changes.

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Dietary Molecular Supplements

1. Glucosamine Sulfate (1500 mg/day) – Aids cartilage repair via chondrocyte stimulation; reduces cytokine-mediated degradation physio-pedia.com.

2. Chondroitin Sulfate (1200 mg/day) – Provides a building block for proteoglycan synthesis; anti-inflammatory effects.

3. Collagen Peptides (10 g/day) – Supports extracellular matrix regeneration; improves tissue tensile strength.

4. Curcumin (500 mg twice daily with food) – Inhibits NF-κB pathway; decreases inflammatory mediators en.wikipedia.org.

5. Omega-3 Fatty Acids (1000 mg EPA/DHA daily) – Compete with arachidonic acid to reduce prostaglandin synthesis.

6. Vitamin D_3 (1000–2000 IU/day) – Modulates bone remodeling; deficiency linked to chronic pain.

7. Calcium Citrate (1000 mg/day) – Essential for bone mineralization; works synergistically with vitamin D.

8. Magnesium (300 mg/day) – Regulates muscle contraction and nerve function; deficiency can worsen spasm.

9. Methylsulfonylmethane (MSM) (1500 mg/day) – Donates sulfur for collagen synthesis; anti-inflammatory.

10. Bromelain (500 mg/day) – Proteolytic enzyme that reduces edema and inflammation.

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Advanced Regenerative & Viscosupplementation Drugs

1. Alendronate (Bisphosphonate) (70 mg weekly) – Inhibits osteoclasts to improve bone density; off-label facet joint loading reduction.

2. Risedronate (35 mg weekly) – Similar bisphosphonate effects on subchondral bone.

3. Zoledronic Acid (5 mg IV yearly) – Potent long-acting bisphosphonate for severe osteoporosis.

4. Platelet-Rich Plasma (PRP) (1–3 mL injection) – Concentrated growth factors stimulate tissue repair; modulates inflammation.

5. Hyaluronic Acid Injection (2 mL into facet joint) – Viscosupplements synovial fluid, reduces friction and pain.

6. Mesenchymal Stem Cell Therapy (1–5 × 10^6 cells) – Promotes regeneration of ligament and cartilage tissues.

7. Autologous Conditioned Serum (Orthokine) – Enriched anti-inflammatory cytokines for joint injection.

8. Bone Morphogenetic Protein-2 (BMP-2) – Recombinant growth factor used in fusion surgeries to enhance osteogenesis.

9. Vertebroplasty Cement Augmentation – Polymethylmethacrylate injection into vertebral body to stabilize microfractures adjacent to facets.

10. Cathepsin K Inhibitor (e.g., odanacatib) – Under investigation to reduce bone resorption; may limit facet subluxation.

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Surgical Interventions

1. Open Posterior Reduction and Instrumentation
   Procedure: Midline exposure, reduction under direct visualization, pedicle screw fixation across injured segment.
   Benefits: Immediate stability, high fusion rates, low recurrence pmc.ncbi.nlm.nih.gov.

2. Anterior Cervical Discectomy and Fusion (ACDF)
   Procedure: Anterior approach, disc removal, interbody graft, plating.
   Benefits: Addresses disc herniation, decompresses cord, restores alignment orthobullets.com.

3. Combined Anterior-Posterior Fusion
   Procedure: Staged or same-sitting dual approach for maximal stability.
   Benefits: Superior biomechanical fixation in complex injuries.

4. Minimally Invasive Posterior Pedicle Screw Fixation
   Procedure: Percutaneous screws under fluoroscopy.
   Benefits: Less muscle trauma, faster recovery.

5. Laminectomy and Fusion
   Procedure: Posterior decompression with fusion implants.
   Benefits: Direct cord decompression in canal compromise.

6. Facet Fusion (Posterior Cervical Fusion)
   Procedure: Facetectomy with bone graft between facets.
   Benefits: Local fusion preserving motion segments above/below.

7. Translaminar Screw Fixation
   Procedure: Screws across laminae to span dislocation.
   Benefits: Avoids anatomical pedicle variations.

8. Cervical Disc Arthroplasty
   Procedure: Joint–preserving disc replacement in select cases.
   Benefits: Maintains segmental motion, reduces adjacent segment stress.

9. Vertebral Body Replacement
   Procedure: Corpectomy with cage insertion.
   Benefits: Indicated when vertebral bodies are compromised.

10. Halo-Vest Immobilization
    Procedure: External fixation with halo ring and vest.
    Benefits: Non-invasive traction for reduction; temporary stabilization in poor surgical candidates.

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Preventive Measures

1. Ergonomic Workstation Setup – Maintain neutral spine during prolonged sitting.

2. Proper Lifting Techniques – Bend knees, keep load close to the body.

3. Regular Core Strengthening – Pilates or similar to support spinal alignment.

4. Weight Management – Reduce axial load on spinal facets.

5. Use of Supportive Seat Belts and Helmets – In vehicles and on motorcycles.

6. Safe Sports Practices – Neck strengthening and protective gear in contact sports.

7. Bone Health Optimization – Adequate calcium/vitamin D intake.

8. Early Intervention for Neck Pain – Address minor sprains before they worsen.

9. Flexibility Programs – Routine stretching of neck and shoulders.

10. Fall Prevention Strategies – Home environment modifications for elderly.

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When to See a Doctor

Seek immediate medical attention if you experience:

• Sudden weakness or numbness in arms/legs

• Loss of bladder or bowel control

• Severe neck pain unresponsive to conservative measures

• Signs of infection (fever, redness, swelling at surgical site)

• New or worsening deformity

• Persistent neurological symptoms

• Intractable pain despite medication

• Symptoms of medication toxicity (e.g., gastrointestinal bleeding)

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What to Do and What to Avoid

What to Do

• Apply ice for acute pain relief

• Use a soft cervical collar briefly if advised

• Perform gentle AROM exercises within pain-free limits

• Maintain proper posture

• Follow a structured physiotherapy program

• Adhere to ergonomic principles

• Pace activities to avoid exacerbations

What to Avoid

• Heavy lifting and sudden neck movements

• Prolonged immobilization without therapy

• High-impact sports until cleared

• Incorrect posture (e.g., forward head)

• Smoking, which impairs tissue healing

• Overreliance on opioid medications

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Frequently Asked Questions

1. What causes unilateral facet dislocation?
   High-energy flexion-rotation injuries—such as motor vehicle collisions or sports trauma—can force one facet joint out of place, tearing ligaments and locking the joint pmc.ncbi.nlm.nih.gov.

2. Can it heal without surgery?
   Nonoperative care (collar, traction, physiotherapy) has high rates of treatment failure (up to 80 %), persistent pain, and risk of neurological decline compared to surgery pmc.ncbi.nlm.nih.gov.

3. How soon after injury is surgery performed?
   Ideally within 12–24 hours to minimize cord compression and maximize neurological recovery, though timing depends on overall patient stability ncbi.nlm.nih.gov.

4. What is the recovery time?
   Fusion surgery patients often wear a collar for 6–12 weeks; full return to activities may take 3–6 months, with physiotherapy continuing throughout.

5. Are there long-term complications?
   Potential adjacent segment degeneration, chronic neck pain, or hardware failure; risk minimized by optimal surgical technique and rehabilitation.

6. Can I drive after surgery?
   Typically not until collar is removed and neck strength/ROM are adequate—often 6–8 weeks postoperatively.

7. Is physical therapy necessary?
   Yes; early, guided physiotherapy improves range of motion, strength, and long-term outcomes emedicine.medscape.com.

8. Are there alternatives to opioids?
   NSAIDs, acetaminophen, muscle relaxants, and neuropathic agents can often control pain without dependence risks.

9. What dietary supplements help healing?
   Glucosamine, chondroitin, collagen, vitamin D, and omega-3 may support tissue repair and reduce inflammation.

10. Can facet dislocation recur?
    Once properly reduced and stabilized, recurrence is rare, provided patients adhere to rehabilitation and avoid high-risk activities.

11. Is regenerative therapy effective?
    Early studies of PRP and stem cells show promise, but more high-quality RCTs are needed.

12. How to prepare for surgery?
    Optimize nutrition, smoking cessation, medical comorbidities management, and prehabilitation exercises.

13. When can I return to sports?
    Low-impact activities may resume at 3 months; full contact sports typically deferred 6–12 months pending surgeon clearance.

14. Do I need a second surgery?
    Rarely, unless hardware fails or nonunion develops; most patients require a single operative event.

15. How to prevent future neck injuries?
    Maintain strong core and neck muscles, practice good ergonomics, and use protective equipment during sports and driving.

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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