case_images: PMC9062954_01
case_images: C4-C5 flexion/distraction with anterior C4-C5 disc extrusion, bilaterally jumped facets, and posterior ligamentous disruption contributing to a highly unstable cervical spine.
case_images: SNI-13-162-g001.jpg
case_images: PMC9062954_01_SNI-13-162-g001.jpg
case_images: F1
case_images: Brain and spine CT/MR studies documented a C4-C5 flexion/distraction injury, an acute anterior disc extrusion with superior migration, complete bilateral jumpted facet joints, and complete disruption of the posterior ligamentous complex [Figure 1].
case_images: T2 Sagittal MRI confirming C4-C5 anterior/superior disc extrusion and a hyperintense signal within the spinal cord.
case_images: SNI-13-162-g002.jpg
case_images: PMC9062954_01_SNI-13-162-g002.jpg
case_images: F2
case_images: The MR also demonstrated a T2 hyperintense signal within the cord at the C4-C5 level, consistent with a SCI (AOSpine classification C4-C5 fracture: C, F4 unilateral, N3, M2.) [Figure 2].
case_images: X-ray confirming 360  reduction and circumferential stabilization at the C4-C5 level.
case_images: SNI-13-162-g003.jpg
case_images: PMC9062954_01_SNI-13-162-g003.jpg
case_images: F3
case_images: A secondary posterior C4-C5 lateral mass screw/ rod fusion was performed to address the posteriorly disrupted ligamentous complex [Figure 3].
case_images: T2 Sagittal MRI at 6-year follow-up confirming a stable C4-C5 fusion with only residual intramedullary myelomalacia secondary to the original spinal cord injury.
case_images: SNI-13-162-g004.jpg
case_images: PMC9062954_01_SNI-13-162-g004.jpg
case_images: F4
case_images: Six-years later, she was clinically normal [Figure 4].