Traumatic intradural disc herniation following a cervical facet dislocation: a case report

Journal of Spine Surgery, 2022 · DOI: 10.21037/jss-21-106 · Published: March 1, 2022

Surgery Trauma Research Methodology & Design

Simple Explanation

This paper describes a unique instance of a patient who experienced an intradural disc herniation due to a left C5-6 unilateral facet dislocation after falling. The herniation wasn't easily detectable through pre-operative imaging, which makes this case particularly noteworthy. The paper details the surgical approach used to address this specific condition, including the challenges and decisions made during the procedure.

Study Duration

1 year follow up

Participants

1 male patient, 65 years old

Evidence Level

Level 4, Case Report

Key Findings

1
Intradural disc herniations can be missed on MRI in cervical spinal trauma cases.
2
Anterior approach is increasingly acceptable for disc herniations in unilateral cervical facet dislocations.
3
Combined anterior and posterior approach was utilized to achieve decompression and stronger fixation.

Research Summary

This case report presents a unique instance of an intradural disc herniation following a cervical facet dislocation, which was difficult to identify on pre-operative MRI. The management involved a combined anterior and posterior surgical approach to decompress the spinal cord and provide strong fixation. The case highlights the utility of the anterior approach in addressing intradural disc herniations that may not be evident on initial MRI scans and contributes to the growing acceptance of the anterior approach for CFD surgery.

Practical Implications

Diagnostic Awareness

Clinicians should be aware that intradural disc herniations can be easily missed on MRI in cervical spinal trauma cases.

Surgical Approach

The anterior approach is an increasingly acceptable approach to tackle disc herniations in unilateral cervical facet dislocations (CFD) surgery.

Combined Approach Consideration

Combined anterior-posterior approach can be useful in cases needing both decompression and strong fixation.

Study Limitations

1
Short term 1 year follow up of the patient
2
The single case may not be generalizable to all patients
3
Difficulty to diagnose with MRI alone and can be concealed as minor disc herniation

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