PMC9062954_01
C4-C5 flexion/distraction with anterior C4-C5 disc extrusion, bilaterally jumped facets, and posterior ligamentous disruption contributing to a highly unstable cervical spine.
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F1
Brain and spine CT/MR studies documented a C4-C5 flexion/distraction injury, an acute anterior disc extrusion with superior migration, complete bilateral jumpted facet joints, and complete disruption of the posterior ligamentous complex [Figure 1].
T2 Sagittal MRI confirming C4-C5 anterior/superior disc extrusion and a hyperintense signal within the spinal cord.
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F2
The MR also demonstrated a T2 hyperintense signal within the cord at the C4-C5 level, consistent with a SCI (AOSpine classification C4-C5 fracture: C, F4 unilateral, N3, M2.) [Figure 2].
X-ray confirming 360  reduction and circumferential stabilization at the C4-C5 level.
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F3
A secondary posterior C4-C5 lateral mass screw/ rod fusion was performed to address the posteriorly disrupted ligamentous complex [Figure 3].
T2 Sagittal MRI at 6-year follow-up confirming a stable C4-C5 fusion with only residual intramedullary myelomalacia secondary to the original spinal cord injury.
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F4
Six-years later, she was clinically normal [Figure 4].