PMC6372996_01
Preoperative images. (a) Lateral radiograph showing antrolesthesis of C4 on C5 with more than 25% translation indicating biarticular injury. (b) Parasagittal T2 weighted MRI at the local hospital showing cord oedema and disc herniation. (c) Repeated MRI 10 weeks later.
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His initial cervical radiographs and magnetic resonance imaging (MRI) were obtained after noticing right-sided weakness (Figure 1(a) and (b)). A repeated MRI that was done under fiberoptic intubation with general anaesthesia on the way to the operating room showed improvement of the abnormal signal intensity and reduction of the impinging C4-5 disc (Figure 1(c)).
Computerised tomography (CT). (a) 3D images of the bilateral facet dislocation (arrows). (b) The right dislocated facet with partial union. (c) The left 'perched' facet.
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We did not perform skull traction as the CT scan did show at least partial healing of the dislocated facets (Figure 2), and we started posteriorly because remodelled facets were felt to be restrictive to any anterior manipulation.
Intraoperative images. (a) The injured facets are shown in the clinical photograph. (b) The reduction manoeuvre used.
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The surgical procedure constituted three approaches, starting posteriorly for facets release, which did not result in reduction (Figure 3(a)), then anteriorly where we did a C5 corpectomy as well as discectomy of the adjacent discs. Despite the small size of the vertebrae, we were able to place divergent distraction pins and used them effectively (Figure 3(b)).
Final radiographs 24 months postoperatively. (a) Anteroposterior. (b) Lateral.
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The final radiographs showed union (Figure 4(a) and (b)).