Traumatic intradural disc herniation following a cervical facet dislocation: a case report
Joshua Song1, Jacob Yoong Leong Oh1
1Department of Orthopaedic Surgery, Spine Division, Tan Tock Seng Hospital, Singapore.
Journal of Spine Surgery (Hong Kong)
|April 20, 2022
Summary
A rare intradural disc herniation following cervical facet dislocation was challenging to diagnose via MRI. Surgical management involved a combined approach, highlighting the importance of considering this diagnosis in spinal trauma.
Area of Science:
- Neurosurgery
- Spinal Surgery
- Trauma Surgery
Background:
- Unilateral cervical facet dislocations (CFD) are significant spinal injuries.
- Intradural disc herniations (IDH) can occur secondary to trauma but are often missed on imaging.
Observation:
- A 65-year-old male sustained a left C5-6 unilateral facet dislocation with an American Spinal Injury Association (ASIA) B cord injury.
- Pre-operative MRI revealed severe C5-6 compression but no overt intradural disc herniation.
- Cerebral spinal fluid (CSF) leakage was noted post-discectomy, indicating a traumatic dural tear from the herniated disc.
Findings:
- The patient underwent closed reduction followed by a combined anterior and posterior surgical approach for the C5-6 disc herniation.
- A traumatic dural tear associated with the IDH was identified.
- The dural tear was not repaired due to the dura's friable nature.
Implications:
- Intradural disc herniations can be subtle and easily missed on MRI in cervical trauma.
- The anterior surgical approach is a viable option for managing disc herniations in CFD.
- Prompt surgical intervention and rehabilitation can lead to functional recovery in spinal cord injuries.
