Bilateral perched facets with cord injury

Case contributed by Dr Andrew Dixon


High speed car accident. Ejected from vehicle. SBP 60 at scene. GCS 3. Intubated. Bilateral chest decompression. On norepinephrine.

Patient Data

Age: 50
Gender: Male

Fracture through the left lateral mass of C1 which involves the foramen transversarium. Fracture through the right lateral mass of C2 which involves the foramen transversarium. Fracture through the right C5 transverse process.  Fracture through the C5 spinous process.

Fracture dislocation at C6-7. Fracture through the anteroinferior corner of the C6 vertebral body. Fracture through the right C6 pedicle extending to the foramen transversarium.  Fracture through the C6 laminae bilaterally and spinous process.

Traumatic anterolisthesis of C6 on C7 by approximately 12 mm.  The left C6-7 facet joint is perched.  The right C6-7 facet joint is perched laterally but locked medially with small fracture fragments seen adjacent.

Anterior epidural haematonma from C2 to C6-7, largest at C6-7.

Moderate anterior epidural hematoma extending from the clivus fracture to C7, with a maximal thickness of 6 mm, abutting the cord throughout its length.  

Small amount of posterior epidural hematoma at C6/7.  Incompletely imaged, likely small volume posterior epidural hematoma at T2-3 level.

C6-7 discoligamentous rupture with bilateral perched facets and 8 mm anterior displacement of C6 on C7. Disruption of the ALL, PLL and ligamentum flavum, as well as the interspinous ligaments.

Disc material/hemorrhage posterior to C6 abuts the cord. The cord is compressed at this level, with evidence of cord hemorrhage.  The abnormal cord signal extends to the C7-T1 level. The rest of the cord has normal signal.

Right C2 lateral mass fracture extending into the odontoid process.  Fluid within the right C1-2 lateral articulation, with mild widening of the joint.  

Clivus and occipital condyle fractures, with tearing of the tectorial membrane at the clivus fracture site.  The apical ligament is torn.  The alar ligaments are intact, with sprain of the left alar ligament.

C7 anterosuperior corner avulsion fracture fragment, with edema along the superior body.

Left C1 lateral mass fracture extending into the foramen transversarium.

T1 vertebral body rounded to T2 hyperintense lesion, with faint T1 hyperintensity in keeping with hemangioma.

Vertebral artery flow voids are maintained throughout.

Large amount of posterior interspinous edema.

Case Discussion

An example of bilateral perched facets with associated 3 column discoligamentous injury, epidural hematoma and cord contusion. 

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Case information

rID: 45587
Published: 31st May 2016
Last edited: 14th Aug 2019
System: Trauma, Spine
Inclusion in quiz mode: Included

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