Traumatic intradural disc herniation following a cervical facet dislocation: a case report

Abstract

We report a unique case of a patient who sustained an intradural disc herniation from a left C5-6 unilateral facet dislocation after a fall. This was not easily identified on pre-operative imaging. We explain the details of our surgical approach in this case report. A 65-year-old male fell into a 2 m drain and sustained a left C5/6 unilateral facet dislocation. He then sustained an American Spinal Injury Association (ASIA) B cord injury. His power was 0/5 from C8 downwards bilaterally but sensation was intact throughout. Magnetic resonance imaging (MRI) showed severe compression at C5/6 but no overt intradural disc herniation. This patient subsequently underwent a closed reduction in the operating theatre followed by a combined anterior and posterior approach for the disc herniation. Cerebral spinal fluid (CSF) leakage was noted upon completion of the C5/6 discectomy and it was discovered that there was a traumatic dural tear from the traumatic disc herniation. The decision was made not to repair the dural tear due to the friable nature of the dura and the potential for adhesive glue to propagate through the spinal cord. An anterior drain was placed for 3 days and then removed, he subsequently underwent rehabilitation and was able to regain power in the affected myotomes. Intradural disc herniations can be easily missed on MRI in the setting of cervical spinal trauma. Hence, the anterior approach is an increasingly acceptable approach to tackle disc herniations in unilateral cervical facet dislocations (CFD) surgery.

Keywords: Cervical facet dislocations (CFD); anterior approach; case report; intradural disc herniation; posterior approach.

Figure 1

Preoperative imaging. (A) Sagittal view from the CT scan of the cervical spine displaying the left unilateral dislocated facet at C5/6; (B) sagittal cut of the MRI cervical spine displaying cord compression at C5/6; (C) axial cut of the MRI cervical spine at C5/6. CT, computed tomography; MRI; Magnetic resonance imaging.

Figure 2

Intra-operative imaging. (A) Pre-reduction radiograph imaging of the cervical spine displaying the dislocation at C5/6; (B) post-reduction radiograph imaging of the cervical spine.

Video 1

Intra-operative assessment during the anterior decompression depicting the dural tear.

Figure 3

Postoperative radiograph imaging displaying the anterior plate and posterior instrumentation. (A) Anterior posterior view; (B) lateral view.

Figure 4

Timeline of events. ED, Emergency Department; MRI, magnetic resonance imaging; ACDF, anterior cervical discectomy and fusion.