Catastrophic failure of anterior fusion for bilateral cervical facet dislocation: illustrative case.

backgroundBilateral facet dislocation results from flexion and distraction forces that tear the posterior ligamentous complex, disrupt the facet joint capsules, and can cause fracture of the superior articular processes of the facet joints, leading to vertebral subluxation and potentially serious spinal cord injury. When clinically feasible, the typical management is rapid closed reduction followed by fusion, typically by means of anterior, posterior, or circumferential fixation. However, the risk of construct failure in the event of anterior-only fixation is not fully understood. Since construct failure can result in recurrent vertebral subluxation and spinal cord injury, understanding the risk and mode of failure can guide clinicians in the selection of the optimal surgical approach. OBSERVATIONS: The authors present a unique case of a failed anterior-alone fusion for bilateral facet dislocation that resulted in spinal cord injury. A subsequent review of the literature identified specific risk factors that can contribute to construct failure. LESSONS: Age, bilateral facet injury, extensive damage to the posterior ligamentous complex, and fractures to the endplate, facets, or pedicles increase the risk of construct failure of anterior-alone fixation following subaxial cervical facet dislocations. A combined anterior-posterior fixation may be recommended in such circumstances. https://thejns.org/doi/10.3171/CASE24563.