A) This 42-year-old female presented with neck pain and hyper-reflexia but no extremity motor or sensory deficits following a motor vehicle accident. An emergency MRI scan was obtained prior to attempting closed reduction of the bilateral facet dislocation in order to exclude a traumatic disc herniation. This sagittal MRI shows a C4–5 dislocation with cord impingement caused by the displacement of the spinal column and a retropulsed C4–5 disc. In patients with displaced cervical spine dislocations without significant neurologic compromise, an emergency neural imaging study, such as an MRI, can influence further management considerably. In this patient closed reduction would probably lead to retropulsion of the C4–5 intervertebral disc into the spinal canal with possible additional neural compromise. B) Treatment consisted of emergency anterior C4–5 discectomy with interbody fusion and plate fixation. The patient continued to demonstrate signs of myelopathy postoperatively, but maintained normal extremity motor and sensory function.