A 69-Year-Old with Neck Pain After a Car Crash

Differential Diagnosis

• Cervical lateral mass fracture separation
• Osteoarthritis
• Perched facet joint
• Synovial cysts of the facet joints

Diagnosis

The correct diagnosis is perched facet joint, a vertebral facet joint whose inferior articular process appears to sit “perched” on the ipsilateral superior articular process of the vertebra below. The oblique view shows a lack of overlap of the c6 and c7 facets and anterolisthesis of c6 on c7. A step-off is noted along the posterior cervical line at c6 and widened interspinous space posteriorly. Additionally, the x-rays reveal significant degenerative changes with multilevel disc space narrowing, end plate spurring, and loss of height of c5 and c6 (likely chronic).

Learnings/What to Look for

• Any further anterior subluxation of the perched facet joint will result in dislocation, with one facet “jumping” over the other and becoming locked in this position
• Complications include spinal cord injury, especially with bilateral involvement or, in the setting of canal stenosis, vertebral artery injury, including dissection, thrombosis, and stroke
• Diagnosis can be confirmed with radiographs, CT scan or MRI

Pearls for Urgent Care Management

• Treatment usually involves closed or open reduction followed by surgical stabilization

Resources

• Sambhaji CJ. Perched facet joint. Radiopaedia. Available at: https://radiopaedia.org/cases/5948. Accessed August 2, 2023.
• Chieng R. Perched facet joint. Radiopaedia. Available at: https://radiopaedia.org/articles/5940. Accessed August 2, 2023.
• Forsthoefel C, Moore DW. Cervical facet dislocations & fractures. Ortho Bullets. Available at: https://www.orthobullets.com/spine/2064/cervical-facet-dislocations-and-fractures. Accessed August 2, 2023.

Acknowledgment: Images and case presented by Experity Teleradiology (www.experity.com/teleradiology).

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