Unilateral perched facet fracture dislocation

Case contributed by Dr Craig Hacking

Presentation

Fall from 2.5m whilst intoxicated.

Patient Data

Age: 22
Gender: Male
Modality: CT

Acute angle kyphosis at C7/T1 with small anterior superior vertebral body corner fracture of T1 and 5mm anterolisthesis of C7 on T1. Perched left C7/T1 facet with C7 inferior articular process fracture. The right C7/T1 facet joint is narrowed but normally aligned. There is widening of the C7/T1 interspinous space and therefore likely rupture of the interspinous, supraspinous ligaments and ligamentum flavum. The extensive artefact through the spinal canal at this level makes assessment of the canal, cord and any potential epidural haematoma difficult. The vertebral canal however demonstrates a minimum AP diameter of 12 mm at this level which is not narrowed. Oedema and fluid between the posterior neck muscles at and above this level. Extensive left paraspinal gas is demonstrated. No other fracture or soft tissue abnormality is identified involving the cervical spine.

Small right PTX, ICC noted.

Conclusion

  • 5mm anterolisthesis of C7 on T1 and perched left C7/T1 facet and C7 inferior articular process fracture. Minor compression fracture of T1. Likely rupture of the interspinous, supraspinous ligaments and ligamentum flavum - MRI recommended.
  • Small right PTX, ICC noted.

MRI confirmed interspinous ligamentous injury.

Modality: CT

Anterior and posterior fusions of C7-T1 with intervertebral space device. All screws are intracortical. No hardware failure. Alignment is within normal limits with the left C7/T1 perched facet now normally located. No new fracture identified. Expected post surgical change in the paraspinal soft tissues. Left anterior surgical drain. Persistent tiny right pneumothorax.

Case Discussion

Great example of a perched facet joint.

With unilateral injury, the vertebrae are usually mal-aligned less than half the width of a vertebral body, wehereas with bilateral injury, the vertebrae are usually malaligned more than half the width of a vertebral body.

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Case Information

rID: 40451
Case created: 22nd Oct 2015
Last edited: 22nd Apr 2017
Systems: Spine, Trauma
Tag: trauma
Inclusion in quiz mode: Included

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