Missed cervical spine subluxation leading to bilateral facet dislocation with severe deformity requiring 360 fixation

Abstract

A 41 year-old male that presented after a fall downstairs and the initial imaging was misinterpreted, missing a subtle abnormality, C5/6 subluxation. The patient presented later with neck pain and further imaging demonstrated bilateral facet dislocation with severe deformity requiring 360 spinal fixation.

Keywords: Cervical spine fracture; Instability; Radiology; Spinal injury; Subluxation; Trauma.

Fig. 1

(A) Admission (December 2019) CT trauma of cervical spine (coronal, sagittal, axial) – (1) posterior widening of the C5/6 disk space, (2) mild slaying of the spinous process and subtle kyphotic malalignment. (B) Admission (December 2019) – left sided facets (C) Admission (December 2019) – right sided facets.

Fig. 2

(A) Admitting (May 2020) CT cervical spine – (1) (*) midline coronal & sagittal slices, (2) left sided facets at C5/6, and (3) right sided facets at C5/6 (axial and sagittal cuts). (B) Admitting (May 2020) MRI cervical spine – (*) evidence of cord compression on the MRI.

Fig. 3

Deformity correction illustrated by the post-operative imaging (May 2020) – posterior cervical laminectomy, decompression and release of facet dislocation followed by C5/6 anterior cervical discectomy, partial C6 corpectomy with cage insertion and anterior plating C5 to C7.