The couple experienced the same car accident, and they received the similar radiological findings of a mild focal kyphosis on C4-5 and straightening of cervical spine under routine X-ray and CT scan ( Fig. The third and fourth cases were a 61-year-old man and his 56-year-old wife, who visited our emergency room with mild neck pain. Fortunately, no further instability was present by the 26-month. ![]() He initially underwent anterior cervical discectomy and fusion with plate on C5-6, and additional posterior fusion was considered if sustained instability was observed during the follow-up period. The injury of ALL was also noted on follow-up MRI. However, his neck pain persisted, and follow-up CT scan and dynamic flexion and extension radiographies presented a subluxation on C5-6. No definite acute fracture line or other deformity was visible, but only subtle high signal intensity was present at the posterior ligament complex including inter- and supraspinous ligaments on T2 fat suppression sagittal MR imaging. He had been admitted 7 weeks previously to another medical center with neck pain caused by the accident, and had been diagnosed with cervical sprain under CT scan, MR imaging, and cervical X-ray including antero-posterior and lateral views. The second case was a 46-year-old man who was transferred to our outpatient department under the impression of subluxation of the facet joint on C5-6 after a motor vehicle accident. She underwent posterior fusion on C5-6 with a lateral mass screw system and interspinous wiring ( Fig. The anterior longitudinal ligament (ALL) and intervertebral disc presented intact, and only a posterior column injury was observed. Subluxation of the facet joint on C5-6 was identified by dynamic flexion and extension radiographies after 9 weeks. She complained of intermittent neck pain and discomfort during follow-up periods at the outpatient department. We decided to prescribe for the patient a conservative treatment, because of a low possibility of instability with the above radiological examination under the Subaxial Cervical Injury Classification (SLIC) 11). The patient was found to have suspicious posterior ligament complex injuries including inter- and supra-spinous ligaments and ligamentum flavum on T2 fat suppression sagittal MR imaging ( Fig. 1C and D, including antero-posterior, lateral, and open mouth views) and CT scan ( Fig. ![]() A spinous process fracture was identified on C5 without involving lamina under routine X-ray ( Fig. She complained of left shoulder and neck pain, and was diagnosed with multiple fractures in the upper and lower extremities. The first case was a 57-year-old woman presenting with multiple trauma caused by a rollover motor vehicle accident.
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