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Differential Diagnosis

  • Cervical lateral mass fracture separation
  • Osteoarthritis
  • Perched facet joint
  • Synovial cysts of the facet joints
Neck Pain After a Car Crash


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


Acknowledgment: Images and case presented by Experity Teleradiology (

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