title: Delayed presentation of cervical ligamentous instability without radiologic evidence.
abstract: METHODS
  A case of delayed presentation of unstable cervical ligamentous injury without radiologic evidence is presented.
  
  
  OBJECTIVE
  To 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.
  
  
  BACKGROUND
  The literature is reviewed.
  
  
  METHODS
  A 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.
  
  
  RESULTS
  Closed 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.
  
  
  CONCLUSIONS
  This 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.
authors.affiliation: Department of Orthopaedic Surgery, University of Texas at Houston Health Science Center, Houston, TX 77019, USA. vishal_shah@alumni.utexas.net
authors.forename: Vishal M
authors.initials: VM
authors.lastname: Shah
authors.forename: Rex A
authors.initials: RA
authors.lastname: Marco
mesh_terms: D001915:Braces; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging* / Q000293:injuries / Q000473:pathology / Q000601:surgery; D017586:Diskectomy; D006801:Humans; D004204:Joint Dislocations / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000601:surgery; D007593:Joint Instability / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000601:surgery; D008023:Ligaments, Articular / Q000000981:diagnostic imaging* / Q000293:injuries / Q000473:pathology / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D016103:Spinal Fractures / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000601:surgery; D013123:Spinal Fusion; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D014143:Traction; D016896:Treatment Outcome