Facet joint fracture treated with ACDF and follow-up

Case contributed by Frank Gaillard



Patient Data

Age: 25 years

Comminuted fracture through the left C5 inferior articular process with extension into the adjacent facet joints results in a 2 mm anterolisthesis of C4 on C5. 

The left C5/C6 facet joint is mildly widened.

Fracture through the anterior tubercle of the left C5 transverse process with extension into the transverse foramen.

Vertebral height and overall alignment are unremarkable, with minor anterolisthesis of C4 and C5 (2 mm). Fracture of the left C5 the facet is noted, better demonstrated on CT. Despite aforementioned anterolisthesis, the cord is not compressed and appears unremarkable at all levels, without evidence of edema or hemorrhage. No neural exit foraminal stenosis.

Extensive edema is seen in the paraspinal musculature on the left side particularly the site of fracture. No significant edema, however, is demonstrated within the interspinous ligament which appears intact. The ligamentum flava appear unremarkable. Posterior and anterior longitudinal ligaments do not appear disrupted, although small high T2 intensity clefts are seen within the anterior and posterior left-sided annular fibers of the C4/C5 disc raising the possibility of partial tears. No significant edema is demonstrated on the right side. T

Conclusion: Fracture of left C5 articular pillar, with the C4/C5 left-sided anterolisthesis. No convincing disruption of the main ligamentous structures and no evidence of cord compression or trauma.

Intraoperative image intensifier used during ACDF with plate and screws. 

The C4/C5 ACDF is noted with mature bony union across the bone graft. Alignment is unremarkable and alignment of the facet joints normal. The previous fracture across the lateral mass of C5 appears united. Neural exit foramina appear capacious.

Case Discussion

Anterior cervical discectomy and fusion (ACDF) is most frequently performed to treat degenerative disc disease leading to cervical cord compression. It is, however, also important in immobilizing cervical spine traumatic instability and can be either performed in isolation (as in this case) or as part of combined anterior and posterior instrumentation.  

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