Spine Case 2 ED Management

Facet Dislocation

Immobilization:

• Hard collar if possible.
• Do not force into a collar if spine is locked.
• Instead use sandbags, towel rolls, and tape.

Closed reduction by spine specialist (often in the ED):

• Halo device

Or

• Gardner-Wells tongs. This involves placing a traction device into the skull and increasing hanging weights at 15 minute intervals until serial radiographs document reduction.
• Neurologic deficit may worsen after closed reduction (from disc protrusion), so serial neurologic exams are crucial.

These injuries are usually subsequently managed operatively.