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Background <p>The incidence of unilateral facet fracture of the cervical spine is approximately 10% of all cases of spinal trauma. Herein, we report an extremely rare case of traumatic nerve root injury due to a unilateral facet fracture of the cervical spine caused by a direct external force.</p> Case presentation <p>A 66-year-old Japanese man was injured by a direct hit from an iron object on the right side of the posterior neck at a construction site and was transported to our hospital. At the initial visit, a neurological examination revealed severe paresthesia of the C8 area and motor weakness of finger extension and abduction on the right side. Computed tomography (CT) revealed a unilateral facet fracture of C7/T1 on the right side. Magnetic resonance imaging (MRI) revealed no injury to the intervertebral disc, supraspinous or interspinous ligament, or spinal cord. We diagnosed him with C8 nerve root injury on the right side due to a unilateral facet fracture of C7/T1 on the right side caused by a direct external force. In the present case, we diagnosed no rotational instability because the cause of injury is a direct external force. Thus, the patient was conservatively treated with Philadelphia collar immobilization for 3 months. His paresthesia in the C8 area on the right side and his motor weakness of finger extension and abduction gradually improved within 2 months after the injury. An X-ray image did not reveal any progression of the C7/T1 facet dislocation. At the final follow-up, 1 year after the injury, his paresthesia or motor weakness was ultimately improved, and CT revealed a complete union of the bony fragment of the facet.</p> Conclusions <p>When a unilateral facet fracture of the cervical spine is treated, conservative treatment may be successful despite the nerve root injury in patients with no rotational instability and no disc or posterior ligament injury. This case highlights the potential for conservative treatment as a viable approach in such cases, suggesting that, when carefully selected, patients may benefit from conservative treatment, contributing to clinical decision-making in similar cases.</p>

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Traumatic nerve root injury due to unilateral facet fracture of the cervical spine caused by a direct external force; a case report

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  • 发表日期：

    2025年12月23日

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  • Hiroshi Takahashi,
  • Yosuke Shibao,
  • Toru Funayama,
  • Hiroshi Noguchi,
  • Kousei Miura,
  • Hisanori Gamada,
  • Shun Okuwaki,
  • Kotaro Sakashita,
  • Takahiro Sunami,
  • Yosuke Ogata,
  • Takane Nakagawa,
  • Masashi Yamazaki,
  • Masao Koda

摘要

Background

The incidence of unilateral facet fracture of the cervical spine is approximately 10% of all cases of spinal trauma. Herein, we report an extremely rare case of traumatic nerve root injury due to a unilateral facet fracture of the cervical spine caused by a direct external force.

Case presentation

A 66-year-old Japanese man was injured by a direct hit from an iron object on the right side of the posterior neck at a construction site and was transported to our hospital. At the initial visit, a neurological examination revealed severe paresthesia of the C8 area and motor weakness of finger extension and abduction on the right side. Computed tomography (CT) revealed a unilateral facet fracture of C7/T1 on the right side. Magnetic resonance imaging (MRI) revealed no injury to the intervertebral disc, supraspinous or interspinous ligament, or spinal cord. We diagnosed him with C8 nerve root injury on the right side due to a unilateral facet fracture of C7/T1 on the right side caused by a direct external force. In the present case, we diagnosed no rotational instability because the cause of injury is a direct external force. Thus, the patient was conservatively treated with Philadelphia collar immobilization for 3 months. His paresthesia in the C8 area on the right side and his motor weakness of finger extension and abduction gradually improved within 2 months after the injury. An X-ray image did not reveal any progression of the C7/T1 facet dislocation. At the final follow-up, 1 year after the injury, his paresthesia or motor weakness was ultimately improved, and CT revealed a complete union of the bony fragment of the facet.

Conclusions

When a unilateral facet fracture of the cervical spine is treated, conservative treatment may be successful despite the nerve root injury in patients with no rotational instability and no disc or posterior ligament injury. This case highlights the potential for conservative treatment as a viable approach in such cases, suggesting that, when carefully selected, patients may benefit from conservative treatment, contributing to clinical decision-making in similar cases.