Perched facets diagnosed in a neurologically intact patient 5 weeks after a fall

Excerpt

A 72-year-old man presented to our hospital’s emergency department (ED) for evaluation of cervical spine instability. Five weeks prior to presentation to our ED, he was trimming a tree, and fell 8–10 ft. The fall rendered him unconscious, and he was taken to an outside hospital where he was evaluated and discharged in a hard collar with scheduled imaging and neurosurgical follow-up in 5 weeks. The patient had cervical spine radiographs obtained prior to his neurosurgical appointment. These images showed perched facets of C4 on C5. The patient was in our vicinity, and was directed immediately to the ED of our hospital. He had neck pain at presentation, but no neurological symptoms. He underwent MRI of the cervical spine, which better characterized the ligamentous extent of the hyperflexion injury. He was evaluated by neurosurgery, and underwent open reduction and internal fixation (ORIF) due to cervical spine instability. Anterior cervical diskectomy and fusion (ACDF) with lordotic allograft spacer and plate and screw fixation was performed. He did well postoperatively, and was discharged in a hard collar. He has no neurologic deficits or symptoms. …