C2 to C3 Traumatic Lateral Dislocation Combined With C3 Fracture Without Neurological Deficits: A Rare Case and Treatment.

Background: Traumatic cervical spine fractures with dislocation are often caused by high-energy injuries, typically from motor vehicle accidents. Hangman's fracture constitutes 4% to 5% of cervical fractures and is usually accompanied by anteroposterior dislocation and/or neurological deficits. However, lateral vertebral dislocation without neurological symptoms is extremely rare. We present a case of C2 to C3 lateral dislocation with C3 fracture in a patient who only reported neck pain and limited mobility.

Methods: This study reports a case of a 42-year-old woman who presented with neck pain after a traffic accident. The patient remained fully conscious throughout the incident, and the patient did not experience any loss of consciousness. Preoperative imaging clearly revealed a split fracture of the right C3 body-pedicle junction and the right vertebral plate, along with anterolateral dislocation of the C2 vertebral body. After a closed reduction of the affected segment, an anterior cervical discectomy and fusion (ACDF) was performed to restore segmental stability of the C2 to C3 level.

Results: A satisfied closed reduction was achieved after a fixed cervical traction. An ACDF was performed to successfully restore the segmental stability of the C2 to C3 level without surgical-related complications. The patient reported alleviation of neck pain (visual analog scale score decreased from 7 preoperatively to 2 postoperatively). Postoperative imaging revealed a satisfactory reduction of fracture-dislocation. At a 2-month follow-up after discharge, the patient had returned to work.

Conclusion: This case demonstrates the feasibility of ACDF as a standalone approach for treating single-stage cervical fractures with associated lateral dislocation following precise and sustained traction reduction. Compared with posterior or combined approaches, the anterior-only technique offers significant advantages, providing a minimally invasive alternative for the management of complex cervical spine trauma.

Clnical relevance: This case highlights that prompt recognition and surgical stabilization of C3 vertebral body fracture with C2-C3 spondylolisthesis can prevent neurological deterioration and improve functional recovery. It provides practical evidence to support early surgical decision-making in rare but severe cervical spine injuries.

Level of evidence: 5: