• Vishal M Shah and Rex A Marco.
• Department of Orthopaedic Surgery, University of Texas at Houston Health Science Center, Houston, TX 77019, USA. vishal_shah@alumni.utexas.net
• Spine. 2007 Mar 1; 32 (5): E168-74; discussion E175.

Study DesignA case of delayed presentation of unstable cervical ligamentous injury without radiologic evidence is presented.ObjectivesTo report a rare case of delayed presentation of cervical ligamentous injury without radiologic evidence, and to discuss diagnosis, initial management, and techniques of operative stabilization.Summary Of Background DataThe literature is reviewed.MethodsA 48-year-old man who sustained a nondisplaced unilateral C6 pillar fracture with no radiologic evidence of ligamentous injury returned for follow-up with radicular pain and bilateral perched facets at C5-C6.ResultsClosed reduction of the cervical subluxation was performed via cervical traction, and subsequent surgical stabilization was undertaken with anterior cervical discectomy and instrumented arthrodesis of C5-C6 with structural interbody autograft. The patient wore a cervical brace for 6 weeks after surgery, and progressed to a stable fusion with pain resolution and no neurologic sequelae.ConclusionsThis is a rare reported case of delayed presentation of an unstable ligamentous injury in a nondisplaced cervical pillar fracture without initial radiologic evidence of instability. If any reason to suspect ligamentous injury exists, workup with upright cervical lateral radiographs, flexion/extension radiographs, or magnetic resonance imaging should be obtained. Awake, closed reduction with cervical traction followed by surgical stabilization with an anterior discectomy and instrumented arthrodesis with structural autograft achieved stable fixation.

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