Cervical spine posterior ligamentous complex rupture

Case contributed by Dr Anthony Nuñez

Presentation

Head and neck injury during a backflip. No neurological symptoms. Mild pain in the neck.

Patient Data

Age: 20 years
Gender: Female

Transoral: Atlanto-axial articular space is symetric. No displacement of C1 lateral masses.

Frontal: Height of vertebral bodies is intact. No scoliosis. 

Lateral: Cervical lordosis rectification. Widened interspinous space at C5-6. Subtle narrowing of the disc space at the C5-6-level in the anterior region. Subtle facet joint subluxation C5-C6. 

Cervical lordosis lost. Widened interspinous space at C5-6. Subtle narrowing of the disc space at the C5-6-level in the anterior region. Better visualization of the facet joint subluxation bilaterally.

No fracture. No epidural hematoma seen on CT. 

Rupture of posterior ligamentous complex: interespinous ligament, supraespinous ligament and flavum ligamentum at C5-C6 level (STIR sequence). 

No cord edema. No epidural collection.

Cervical spine

X-ray

Follow up: osteofixation devices at C5-C6 in order to prevent kyphosis. 

Case Discussion

Posterior ligamentous complex rupture associated with facet subluxation typical of a hyperflexion injury. No cord edema in this patient. No symptoms after injury. Osteofixation devices are necessary in order to prevent kyphosis and collapse. 

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