Blunt Traumatic Posterior Cord Syndrome Following a Hangman Fracture: A Case Report.

Introduction: Posterior cord syndrome (PCS) sits outside the five incomplete spinal cord injury (SCI) syndromes formally recognized by the International Standards for Neurological Classification of SCI, and carries a reported incidence below 1%. Because routine neurological screening often skips detailed dorsal column testing, PCS is thought to be substantially under-diagnosed, and traumatic PCS in particular has only been described in a handful of published reports, nearly all in the cervical spine. Case Report: A 24-year-old man sustained a hyperextension injury of the cervical spine in a road traffic accident, presenting with whole-body paresthesia, neck pain, and asymmetric upper-limb weakness. Computed tomography demonstrated a C1 transverse process fracture, a hangman fracture with associated lamina, spinous process, and teardrop fracture components of C2, and a C3 spinous process fracture without subluxation. Magnetic resonance imaging (MRI) showed faint diffuse cord edema and anterior longitudinal ligament disruption at C2-C3. He underwent anterior cervical interbody fusion at C2-C3 with halo immobilization and made a near-complete neurological recovery over 1 year, retaining only mild residual proprioceptive deficits in the hands and feet. Follow-up MRI obtained 10 months after injury anatomically localized the injury to the posterior columns, confirming PCS. Conclusion: This case shows how traumatic PCS can be overlooked on early imaging and only becomes anatomically apparent on delayed MRI. A structured sensory examination that specifically tests proprioception and vibration, combined with repeat imaging when symptoms persist, is essential for correctly identifying this rare and likely under-recognized injury pattern.