Diagnosis of Cervical Distractive-Flexion Injury Based on Minor Facet Fracture and Subtle Widening of the Facet Joint...

Cervical distractive-flexion (DF) injuries are occasionally overlooked on initial evaluation, leading to delayed diagnosis at the stage of dislocation or late-onset neurological symptoms. Although detailed evaluation of osseous injury has become possible with the widespread use of CT, diagnosis remains challenging when DF injuries are spontaneously reduced in the supine position during imaging. According to the Allen-Ferguson classification, minor fractures of the superior articular process are indicative of DF injuries; however, few reports mention the evaluation of such findings in cases of delayed dislocation. This report presents a case of DF injury (Stage 1) diagnosed by recognizing a minor fracture of the articular process and subtle widening of the contralateral facet joint, leading to appropriate imaging evaluation and timely diagnosis.