Disclosures: Edmund JR. Neo, MBBS, MRCP (UK), MMed (Int Med, S’pore): No financial relationships or conflicts of interest

Case Description: The patient presented initially with neck pain after a fall. Neurological examination was unremarkable and a neck radiograph was reported as normal, resulting in discharge with analgesia. He re-attended 3 days later with worsening weakness in the left shoulder and both lower limbs, as well as urinary incontinence. CT of the cervical spine revealed grade 2 C5-C6 anterolisthesis with bilateral locked facet joints and fractures of the C6 superior articular processes. MRI demonstrated severe cervical canal narrowing with cord compression at the same level. He underwent emergency reduction, posterior instrumentation, anterior cervical discectomy, and fusion, before being transferred to the rehabilitation unit.

Setting: Tertiary hospital

Patient: 69-year old male with no past medical history Assessment/

Results: He progressed well with therapy and was subsequently discharged without a urinary catheter. At 3 months post-injury he had achieved near-complete neurological recovery and could ambulate without assistance. On further investigation the left shoulder weakness was found to also be contributed by rotator cuff tendinopathy.

Discussion: Despite the severity of his radiological findings and the extent of cord involvement, he had surprisingly minor corresponding physical deficits and recovered well. Locked facet joints are typically caused by traumatic hyperflexion or buckling injuries to the cervical spine and appear stable due to the interlocking of the articular processes. However, patients with bilateral lesions experience near-total disruption of the vertebral ligaments and should hence be treated urgently with surgical stabilisation. Facet joint injuries are commonly-missed on plain film radiographs and the subtlety of early clinical features such as in this case highlight the need for a high index of suspicion based on the presenting history. The left shoulder weakness was a confounder and demonstrates the need to consider multiple pathologies during rehabilitation of patients with spinal cord injuries.

Conclusion: Bilateral locked facet joints are severe and easily-missed injuries that necessitate urgent management.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/cervical-spine-instability-due-to-bilateral-locked-facet-joints-a-case-report/