Case Description

History:

The patient is a 32 y.o. male who was flipped off his ATV while riding over sand dunes. He landed on his head while it was in a chin to chest position and had immediate pain in his neck. The patient did not lose consciousness and had full function of all extremities at the time of the injury. He was life-flighted to the E.R. about two hours ago with a possible neck fracture. He denies any other injuries. PMH and PSH are not significant.

Examination:

A WD/WN 32 y.o. male patient, who is alert, oriented and stabilized in a neck collar. He has market tenderness with moderate swelling over the posterior cervical region. Spinous processes are not well identified on palpation. He has complete motor and sensory function in all extremities and his vital signs are stable. Cross-table lateral cervical x-ray done in the E.R. demonstrates bilateral dislocated facets at C4-5. An emergency CT scan was obtained.

Review the following CT scans for important findings.

Here are the important findings:

  1. Evidence of bilateral dislocated facets at C4-5.
  2. Instability of the cervical spine as demonstrated on the Mid-Sagittal view which demonstrates splayed spinous processes, an indication of potential disruption of the posterior ligamentous complex.

What is the next step, closed reduction or MRI scan?

Reduction First MRI First