Dislocation of the Vertebra

First aid: what to do if a spine injury is possible

1. Call 911 or your local emergency number.
2. Do not move the person unless they are in immediate danger, such as fire or traffic.
3. Keep the head and neck still in the position you found them. Kneel behind the head and hold it gently with both hands, or place rolled towels on each side.
4. Do not remove a helmet unless the person is not breathing and you need to reach the airway.
5. If they vomit or must be moved, log-roll them with several helpers, keeping the head, neck and body in a straight line.
6. Keep them warm. Spinal cord injury can impair temperature control.

What a vertebral dislocation is

Each vertebra is linked to the one above and below by a disc at the front and two small facet joints at the back, all held by strong ligaments. In a dislocation, enough force tears these ligaments that the facet joints lose contact. The vertebra above slides forward, rotates or overrides the one below.

Doctors describe the injury by how much the facets have moved:

A pure dislocation without a fracture is most common in the neck, where the facet joints are flatter. In the chest and lower back, the forces needed are so large that dislocation is nearly always combined with fractures, called a fracture-dislocation. For broken spinal bones without displacement, see vertebral fracture.

Dislocation versus spondylolisthesis

Spondylolisthesis also means one vertebra slipping forward on another, but it develops slowly from a stress fracture or joint wear. A traumatic dislocation happens in a moment and is an unstable injury.

Causes

• Motor vehicle crashes, the leading cause, especially rollover and ejection
• Diving into shallow water, which drives the head down and forward
• Falls: from ladders, roofs or horses in younger adults, and simple falls from standing in older adults with stiff or fragile spines
• Contact sports: football tackles with the head down, rugby scrums, ice hockey and gymnastics
• Violence, including gunshot injuries

People with conditions that weaken or stiffen the spine can dislocate after much less force. These include rheumatoid arthritis and Down syndrome, which loosen the upper neck joints (atlantoaxial instability), and ankylosing spondylitis, where a fused spine snaps like a rod.

Symptoms

• severe neck pain or back pain at the level of injury, worse with any movement
• muscle spasm and a head held in a twisted position (with a one-sided facet dislocation)
• a visible step or gap when the spine is felt
• numbness, tingling or burning pain down an arm or leg from a pinched nerve root
• weakness or paralysis below the level of the injury
• loss of bladder or bowel control
• with a high neck injury: difficulty breathing, low blood pressure and a slow pulse (neurogenic shock)

Some people, especially with a unilateral facet dislocation, have only neck pain and stiffness and walk into the ER.

Diagnosis

Paramedics immobilize the spine based on how the injury happened. In hospital, doctors use rules such as the Canadian C-Spine Rule to decide who needs imaging, then:

• a full neurological exam of strength, sensation and reflexes, including the area around the anus, which classifies any spinal cord injury on the ASIA scale
• a CT scan, the main test, which shows the alignment, the facet joints and any fractures
• an MRI scan, which shows cord swelling or bruising, torn ligaments and any disc pushed into the canal
• CT angiography in some neck injuries, to check the vertebral arteries, which run through the neck bones and can tear

Treatment

Realignment (reduction)

The aim is to put the vertebrae back in line quickly to take pressure off the cord. In an awake, cooperative patient with a neck dislocation, surgeons often use closed reduction: tongs or a halo ring are attached to the skull and weights are added gradually while the patient is checked for any new symptoms. Some surgeons first obtain an MRI to look for a disc fragment that could be pushed into the cord.

Surgery

Almost all dislocations are unstable because the ligaments are torn, so surgery is the standard treatment:

• Open reduction if closed reduction fails
• Decompression to remove disc or bone pressing on the cord or nerves
• Spinal fusion with screws, rods or plates from the front, back or both, to hold the level until the bones knit

Early surgery, within about 24 hours, is linked to better neurological recovery in people with cord injury.

After surgery

A collar or brace may be worn for several weeks. People with spinal cord injury move on to specialist rehabilitation, with physical and occupational therapy, bladder and bowel programs, and prevention of pressure sores and blood clots.

Outlook

The outcome depends mainly on whether the spinal cord was injured and how completely. A dislocation with no cord damage that is fixed well usually leads to a good recovery, with some loss of movement at the fused level. People with an incomplete cord injury often regain meaningful strength over 6 to 12 months. A complete cord injury, more common with bilateral facet dislocations, rarely recovers below the level of injury, though rehabilitation can greatly improve independence.

Frequently asked questions

What are the symptoms of a dislocated vertebra?

Severe neck or back pain after a major injury, muscle spasm, and often numbness, tingling or weakness in the arms or legs. Some people lose bladder or bowel control or cannot move below the injury. A few have only pain and stiffness, which is why imaging is needed after high-risk injuries.

Can a dislocated vertebra heal on its own?

No. A traumatic dislocation tears the ligaments that hold the spine together, so it remains unstable and can damage the spinal cord with movement. It needs realignment, and most cases need surgical fixation and fusion to heal safely.

Is a dislocated vertebra the same as a slipped disc?

No. A slipped or herniated disk is the soft cushion between vertebrae bulging out, and the bones stay aligned. A dislocated vertebra is the bone itself displaced, usually from major trauma. A disc can rupture at the same time as a dislocation, which is one reason MRI is used.

How long is recovery after surgery for a spinal dislocation?

Fusion usually takes 3 to 6 months to become solid. Without spinal cord injury, many people return to desk work within a few months and to most activities within 6 to 12 months. With cord injury, rehabilitation often continues for a year or longer.

Can you walk with a dislocated vertebra?

Sometimes. A one-sided facet dislocation in the neck may cause only pain and stiffness, and people can walk. That is why anyone with neck pain after a significant fall, crash or diving injury should keep still and be assessed in an ER.