Blunt Traumatic Posterior Cord Syndrome Following a Hangman Fracture: A Case Report

Posterior cord syndrome (PCS) sits outside the five incomplete spinal cord injury (SCI) syndromes formally recognized by the International Standards for Neurological Classification of SCI, and carries a reported incidence below 1%. Because routine neurological screening often skips detailed dorsal column testing, PCS is thought to be substantially under-diagnosed, and traumatic PCS in particular has only been described in a handful of published reports, nearly all in the cervical spine.

A 24-year-old man sustained a hyperextension injury of the cervical spine in a road traffic accident, presenting with whole-body paresthesia, neck pain, and asymmetric upper-limb weakness. Computed tomography demonstrated a C1 transverse process fracture, a hangman fracture with associated lamina, spinous process, and teardrop fracture components of C2, and a C3 spinous process fracture without subluxation. Magnetic resonance imaging (MRI) showed faint diffuse cord edema and anterior longitudinal ligament disruption at C2-C3. He underwent anterior cervical interbody fusion at C2-C3 with halo immobilization and made a near-complete neurological recovery over 1 year, retaining only mild residual proprioceptive deficits in the hands and feet. Follow-up MRI obtained 10 months after injury anatomically localized the injury to the posterior columns, confirming PCS.

This case shows how traumatic PCS can be overlooked on early imaging and only becomes anatomically apparent on delayed MRI. A structured sensory examination that specifically tests proprioception and vibration, combined with repeat imaging when symptoms persist, is essential for correctly identifying this rare and likely under-recognized injury pattern.