Bilateral perched cervical facet joints: hyperflexion injury

Case contributed by Dr Chris O'Donnell


Gymnast who landed heavily on her head during a tumble causing severe neck pain and pins/needles in her hands. Now rigid neck.

Patient Data

Age: 18
Gender: Female

C5 displaced anteriorly in relation to C6, with widening of the interspinous space and subluxed facet joints.

CT performed on the basis of the radiographic findings


The facet joints at C5-6 on the axial scan are so called "bare" (arrows), i.e. they do not have the normal cupped appearance because of the subluxation. On the sagittal reconstructions, the inferior facets of C5 are perched on the superior facets of C6, and are just about to dislocate. This is due to the hyperflexion leading to interspinous ligament rupture. Note the additional minor but definite forward slip of the C5 vertebral body in relation to C6.

Case Discussion

Perched facets is a subtype of cervical facet subluxation, in which there is loss of apposition of the articular surfaces, such that the tip of the inferior articular process only abuts, without extending past, the superior articular process.

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