» Articles » PMID: 35441104

Traumatic Intradural Disc Herniation Following a Cervical Facet Dislocation: a Case Report

Overview
Journal J Spine Surg
Date 2022 Apr 20
PMID 35441104
Authors
Affiliations
Soon will be listed here.
Abstract

We report a unique case of a patient who sustained an intradural disc herniation from a left C5-6 unilateral facet dislocation after a fall. This was not easily identified on pre-operative imaging. We explain the details of our surgical approach in this case report. A 65-year-old male fell into a 2 m drain and sustained a left C5/6 unilateral facet dislocation. He then sustained an American Spinal Injury Association (ASIA) B cord injury. His power was 0/5 from C8 downwards bilaterally but sensation was intact throughout. Magnetic resonance imaging (MRI) showed severe compression at C5/6 but no overt intradural disc herniation. This patient subsequently underwent a closed reduction in the operating theatre followed by a combined anterior and posterior approach for the disc herniation. Cerebral spinal fluid (CSF) leakage was noted upon completion of the C5/6 discectomy and it was discovered that there was a traumatic dural tear from the traumatic disc herniation. The decision was made not to repair the dural tear due to the friable nature of the dura and the potential for adhesive glue to propagate through the spinal cord. An anterior drain was placed for 3 days and then removed, he subsequently underwent rehabilitation and was able to regain power in the affected myotomes. Intradural disc herniations can be easily missed on MRI in the setting of cervical spinal trauma. Hence, the anterior approach is an increasingly acceptable approach to tackle disc herniations in unilateral cervical facet dislocations (CFD) surgery.

Citing Articles

Intradural Disk Herniation at the Conus Medullaris: A Case Report With Emphasis on Patient Positioning and Neuromonitoring.

Kelly M, Burkhard M, Altorfer F, Emerson R, Sama A JBJS Case Connect. 2025; 14(4.

PMID: 39841040 PMC: 11581431. DOI: 10.2106/JBJS.CC.24.00235.

References
1.
Lee W, Wong C . Anterior-Alone Surgical Treatment for Subaxial Cervical Spine Facet Dislocation: A Systematic Review. Global Spine J. 2020; 11(2):256-265. PMC: 7882821. DOI: 10.1177/2192568220907574. View

2.
Kwon B, Fisher C, Boyd M, Cobb J, Jebson H, Noonan V . A prospective randomized controlled trial of anterior compared with posterior stabilization for unilateral facet injuries of the cervical spine. J Neurosurg Spine. 2007; 7(1):1-12. DOI: 10.3171/SPI-07/07/001. View

3.
Brodke D, Anderson P, Newell D, Grady M, Chapman J . Comparison of anterior and posterior approaches in cervical spinal cord injuries. J Spinal Disord Tech. 2003; 16(3):229-35. DOI: 10.1097/00024720-200306000-00001. View

4.
Lins C, Prado D, Joaquim A . Surgical treatment of traumatic cervical facet dislocation: anterior, posterior or combined approaches?. Arq Neuropsiquiatr. 2016; 74(9):745-749. DOI: 10.1590/0004-282X20160078. View

5.
Sethy S, Ahuja K, Ifthekar S, Sarkar B, Kandwal P . Is Anterior-Only Fixation Adequate for Three-Column Injuries of the Cervical Spine?. Asian Spine J. 2020; 15(1):72-80. PMC: 7904484. DOI: 10.31616/asj.2019.0225. View