Introduction <p>Neglected bilateral cervical facet dislocations are rare, particularly in patients who remain neurologically intact. In elderly individuals, the absence of neurological deficits may delay diagnosis, as persistent neck pain is often attributed to pre-existing degenerative cervical disease.</p> Case presentation <p>An 82-year-old man presented eight months after a motor vehicle collision with persistent mechanical neck pain and restricted cervical range of motion. Neurological examination was normal. Imaging revealed a neglected complete bilateral C5–C6 facet dislocation. Computed tomography demonstrated anterior column osseous bridging occurring in the displaced configuration, a finding suggestive of evolving stabilization. Given the absence of neurological deficit, absence of interval radiological progression, advanced age, and the patient’s preference to avoid surgery, conservative management with cervical immobilization and structured clinical and radiological surveillance was adopted. At one-year follow-up, the patient remained neurologically intact with unchanged imaging findings and satisfactory pain control.</p> Conclusion <p>This case highlights the importance of systematic cervical spine imaging in trauma patients with persistent neck pain, even in the absence of neurological deficits. Although surgical stabilization is generally recommended for chronic bilateral facet dislocations, carefully selected elderly patients demonstrating absence of interval radiological progression and progressive anterior column osseous bridging may be considered for cautious conservative management under close surveillance. Such an approach should remain individualized and requires further validation through additional reports and longer follow-up.</p>