Abstract
Is That Only a Spinous Process Fracture? Report of a Case of a C6 Spinous Process Fracture with Accompanying Complex Ligamentous Injury Resulting in a Delayed Unilateral Facet Dislocation at the C6-7 Level
Highlights
Isolated spinous process fractures are considered as benign injuries of the cervical spine [1,2], their role as “sentinel” in complex spinal injuries was already recognized about thirty years ago [3]
We report a case of a C6 spinous process fracture with initially undetected ligamentous injury at the C6-7 level which led to secondary unilateral facet dislocation at C6-7
Halliday et al tried to predict clinical instability using magnetic resonance imaging (MRI) in patients with unilateral lateral mass/facet fractures. They found that the degree of ligamentous injury at the level of the fracture correlates with instability and found that patients with an injury of at least three of the following four structures - facet capsule, interspinous ligament, anterior longitudinal ligament and posterior longitudinal ligament - may require operative stabilization [21]
Summary
Isolated spinous process fractures are considered as benign injuries of the cervical spine [1,2], their role as “sentinel” in complex spinal injuries was already recognized about thirty years ago [3]. We report a case of a C6 spinous process fracture with initially undetected ligamentous injury at the C6-7 level which led to secondary unilateral facet dislocation at C6-7. This case shows the importance of repeated clinical examinations together with adequate imaging studies to avoid secondary dislocation with the risk of neurologic injury. Spinous process fractures of this kind are considered as stable injuries [1] conservative treatment was initialized; the patient was admitted for observation and was provided with a soft cervical collar for pain reduction. CT of the cervical spine (Figure 1) showed fracture of the C6 spinous process and degenerative changes of the C6-7 segment. Postoperative X-rays revealed an anatomic reduction and the 3 months follow up showed fusion of the C6-7 segment
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