Subacute Instability of the Cervical Spine

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Abstract
Subacute instability of the cervical spine is defined as the development of radiographic evidence of cervical instability within 3 wk of a cervical spine injury when initial adequate roentgenograms show no bony or soft tissue abnormality. Patients (6) who conform to this definition were found to have developed neurologic deficit and radiographic evidence of instability of the cervical spine on repeat examination when none was present initially. There were 4 unilateral facet dislocations (2 [cervical] C5-C6, 1 C6-C7, 1 C4-C5), 1 perched facet (C5-C6) and 1 extension subluxation (C4-C5). The mechanism of subacute instability is thought to be due to the elastic and plastic deformation of the ligamentous structures and discs of the cervical spine. An algorithm is described for evaluation of patients with cervical trauma and initial normal radiographs. By alerting physicians to the entity of subacute instability of the cervical spine, it is hoped that injuries of this nature will be discovered so that appropriate treatment can be rendered before a fixed deformity develops.

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