Traumatic Bilateral Perched Facet of the Thoracic Spine With Associated Vertebral Fracture: A Case Report

Bilateral perched facets of the cervical spine are relatively common in trauma cases; however, similar injuries in the thoracic spine are exceedingly rare due to the inherent stability provided by the rib cage and associated ligamentous structures. We report a rare case of bilateral perched facets at the T10/11 level in a 17-year-old female gymnast who fell from a height of 3 m during training. She presented with severe back pain but no neurological deficits and was ambulatory on arrival. Imaging revealed bilateral perched facets without fracture of facet joints or spinal cord compression, but with evidence of posterior ligamentous complex injury. The Thoracolumbar Injury Classification and Severity Score was 7, indicating instability. Hyperextension reduction was successfully performed, followed by posterior spinal fusion with instrumentation due to persistent instability. The patient recovered well postoperatively and was discharged with no neurological deficits. This case highlights the importance of considering unstable thoracic spine injuries, even in the absence of neurological symptoms, following high-energy trauma. Accurate diagnosis and timely surgical intervention are essential to prevent potentially severe outcomes.