Delayed presentation of cervical ligamentous instability without radiologic evidence

Vishal M. Shah, Rex A.W. Marco

Research output: Contribution to journalArticle

10 Scopus citations

Abstract

STUDY DESIGN. A case of delayed presentation of unstable cervical ligamentous injury without radiologic evidence is presented. OBJECTIVES. To report a rare case of delayed presentation of cervical ligamentous injury without radiologic evidence, and to discuss diagnosis, initial management, and techniques of operative stabilization. SUMMARY OF BACKGROUND DATA. The literature is reviewed. METHODS. A 48-year-old man who sustained a nondisplaced unilateral C6 pillar fracture with no radiologic evidence of ligamentous injury returned for follow-up with radicular pain and bilateral perched facets at C5-C6. RESULTS. Closed reduction of the cervical subluxation was performed via cervical traction, and subsequent surgical stabilization was undertaken with anterior cervical discectomy and instrumented arthrodesis of C5-C6 with structural interbody autograft. The patient wore a cervical brace for 6 weeks after surgery, and progressed to a stable fusion with pain resolution and no neurologic sequelae. CONCLUSIONS. This is a rare reported case of delayed presentation of an unstable ligamentous injury in a nondisplaced cervical pillar fracture without initial radiologic evidence of instability. If any reason to suspect ligamentous injury exists, workup with upright cervical lateral radiographs, flexion/extension radiographs, or magnetic resonance imaging should be obtained. Awake, closed reduction with cervical traction followed by surgical stabilization with an anterior discectomy and instrumented arthrodesis with structural autograft achieved stable fixation.

Original languageEnglish (US)
JournalSpine
Volume32
Issue number5
DOIs
StatePublished - Mar 1 2007

Keywords

  • Anterior cervical arthrodesis
  • Cervical dislocation
  • Cervical pillar fracture
  • Cervical subluxation
  • Delayed cervical instability

ASJC Scopus subject areas

  • Physiology
  • Clinical Neurology
  • Orthopedics and Sports Medicine

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