Unstable Multi-Level Ligamentous Injury of the Cervical Spine in an Adolescent

Purpose: Unstable ligamentous injuries to the cervical spine are unusual within the adolescent population, being more common in younger children. Multi-level unstable ligamentous injuries are rare. Current radiological screening techniques are performed supine. These may miss the dynamic instability of such injuries when under physiological load. Methods: We examine a case report of an adolescent suffering an atypical multi-level disc-and-ligamentous injury of the cervical spine during rugby. Results: The instability of the injury at multiple levels was not obviously apparent on CT, MRI or supine radiographs, as per standard screening protocols, and was only revealed via sequential regular erect radiographs; requiring significant intervention in the form of sequential operations. Conclusions: Sequential erect radiographs are useful and important in monitoring the stability of atypical cervical spine injuries under physiological load.