The patient was transferred from another hospital with history of falling down three days ago, during diving, during what he got flexion facture of the C5.

MRI cervical spine performed 26-March-2007 showing the fracture of C5 without disc prolapse and intact spinal cord.

On examination: the patient is neurologically free with collar and cut wound of the scalp in the forehead. There is slight weakness both legs. Considering that the fracture is an unstable one, reduction and stabilization was suggested.

Discectomy of C4-5 was performed to secure the process of reduction with distraction, using the Hallo ring with 8 Kg applied with slight hyperextension. Using three level 24 mm length Stryker cervical miniplate, fusion of C4-6 with 18 mm screws applied with divergent angulations, to aid the distraction and consequently the reduction. The most difficult part of surgery was to insert the construct to the intended site, due to small incision. Several check X-rays demonstrated good alignment and reduction of the bony structures.

Routine closure of the wound and smooth postoperative recovery with improvement of the motor power both feet.

Considering that the fracture is an unstable one and cannot stand load with severe angulations and decrease of the anterior height of the body of C5 less than 10% than normal, reduction and fusion of the fracture one level above and one level below must be done.

To avoid slippage of the fractured C5 during reduction and fixation, discectomy of C4-5 was performed and the body of C5 was left without screwing to prevent such possible complication. This was done with visual control through the discectomy site.