Related Experiment Video
Updated: Feb 26, 2026
Modified Posterior Vertebral Column Resection for Patients with Thoracolumbar Kyphotic Deformity
Published on: September 16, 2022
Absent congenital cervical pedicle nearly misdiagnosed as a facet dislocation: A case report
Scott Safir1, Jonathan Rasouli2, Jeremy Steinberger2
1Department of Surgery, Mount Sinai Health System, New York, NY 10029, United States.
Insights
Congenital absent cervical pedicle in infants can mimic facet dislocation on imaging. Early, accurate diagnosis using advanced imaging and interdisciplinary communication is crucial to avoid unnecessary surgery for pediatric spinal trauma.
Area of Science:
- Pediatric Radiology
- Pediatric Neurosurgery
- Spinal Trauma Imaging
Background:
- Pediatric cervical spinal injuries are rare but challenging due to difficulties in obtaining reliable neurological exams in infants.
- Advanced imaging like CT scans and MRI are essential for diagnosing cervical spine injuries in pediatric trauma patients.
Purpose of the Study:
- To highlight the diagnostic challenges in differentiating congenital absent cervical pedicle from unilateral facet dislocation in pediatric trauma.
- To emphasize the importance of advanced imaging and interdisciplinary collaboration in accurate diagnosis and management.
Main Methods:
- A case report of a 15-month-old boy with a history of unwitnessed fall.
- Initial CT scan interpretation suggesting unilateral facet dislocation.
- Subsequent advanced imaging and interdisciplinary review leading to the correct diagnosis of congenitally absent left C5 pedicle.
Main Results:
- The patient was initially misdiagnosed with unilateral facet dislocation.
- Congenital absent left C5 pedicle was confirmed after further imaging and discussion.
- Surgical intervention was avoided due to the correct diagnosis.
Conclusions:
- Congenital absent cervical pedicle can be mistaken for unilateral facet dislocation in acute pediatric trauma.
- High index of suspicion, advanced imaging, and neurosurgery-radiology collaboration are vital for accurate diagnosis.
- Correct diagnosis prevented potentially high-morbidity surgery in this pediatric patient.
Background:
Cervical spinal injury encompasses up to 1.5% of all pediatric injuries. Children, and more specifically infants, are a difficult subset of patients to obtain neurological exam in the setting of trauma, thus necessitating the use of cervical X-rays, CT scans, and MRI imaging.
Case Description:
A healthy, 15-month-old boy had an unwitnessed fall down a flight of stairs and received a CT scan of the head and cervical spine in the emergency department due to cephalohematoma and mechanism of injury. The patient was initially diagnosed with a unilateral facet dislocation but after additional imaging and rigorous interdisciplinary discussions, the patient was correctly diagnosed with a congenitally absent left C5 pedicle. Surgical intervention was not pursued and the patient was discharged home with close follow up.
Conclusion:
In the acute trauma setting, congenital absent cervical pedicle can be difficult to differentiate from unilateral facet dislocation and may require the use of advanced imaging and close communication between the neurosurgery and radiology departments. Given the high morbidity and mortality involved in the repair of facet dislocation in a child, it is crucial to maintain high degree of clinical suspicion for absent spinal pedicle. In this case, the patient nearly underwent surgical intervention, but was ultimately able to be discharged home with no symptoms or deficits after correct diagnosis.
