Thread by @RyanChristieMD

#WetreadCow Case 4

Hx: MVA, neck pain

Please answer with professionally appropriate gif responses only. No spoilers! wetread.org #FOAMrad #FOAMed #radres #errad #Neurorad #MSKRad

#WetreadCow Case 4

Answer: Unilateral Facet Dislocation

Normal L & R superior articular facets overlap/aligned to the C6-C7 where 1 is shifted anterior(red dash)

-Ant & post vertebral lines (green) ?ok
-Spinolaminar line (orange)=broken ❌
-Post spinous line (purple) = gap ❌

Perched facet = subluxed joint with tip of inferior facet resting on tip of super facet of lower body

Dislocated/jumped/locked facet = complete dislocation with inferior tip ANTERIOR to superior facet of lower body (thus "locked")

Get the CT and ALWAYS 👀 for the fracture!

Unilateral jumped facets can be tough on X-ray as the vert body doesn't have to displace much (vert lines ok). ALWAYS look at spinolaminar & post spinous lines!

Facets = "shingles on a roof"

Any abrupt change/rotation should be concerning! #FOAMrad #Neurorad #ERrad #radres

For completeness, here is a bilateral facet dislocation. ALL spinal lines disrupted.😮

No rotation. Both inferior facets jumped and locked anterior to the superior facets of the lower body.

-MRI=diffuse ligamentous injury
-neurologically devastating
#NeuroRad #radres #FOAMrad