Delayed presentation of cervical ligamentous instability without radiologic evidence

Area of Science:

• Orthopedic Surgery
• Neurosurgery
• Spinal Diagnostics

Background:

• Cervical ligamentous injuries can present with delayed symptoms and subtle radiographic findings.
• Nondisplaced cervical pillar fractures may mask underlying instability.
• Literature review indicates rarity of such presentations.

Observation:

• A 48-year-old male presented with delayed radicular pain and bilateral perched facets at C5-C6.
• Initial imaging of a unilateral C6 pillar fracture showed no radiologic evidence of ligamentous injury.
• Delayed presentation occurred despite a nondisplaced fracture.

Findings:

• Closed reduction via cervical traction successfully addressed the subluxation.
• Surgical stabilization involved anterior cervical discectomy and instrumented arthrodesis of C5-C6 with an autograft.
• Achieved stable fusion with pain resolution and no neurological deficits post-operatively.

Implications:

• Emphasizes the need for thorough workup, including advanced imaging (MRI, flexion/extension views), when cervical instability is suspected despite initial negative radiographs.
• Demonstrates the efficacy of awake closed reduction with traction followed by surgical stabilization for delayed unstable cervical injuries.
• Highlights the importance of considering ligamentous injury in cases of delayed presentation with cervical facet joint pathology.