Missed Cervical Spine Fracture-dislocations: The Importance of Clinical and Radiographic Assessment

Missed Cervical Spine Fracture-dislocations:
The Importance of Clinical and Radiographic Assessment

This section is compiled by Frank M. Painter, D.C.
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FROM:   J Manipulative Physiol Ther 2002 (May);   25 (4):   263269

Steven W. King, DC, Bryan K. Hosler, Mark A. King, DC, Eric W. Eiselt, DC

Motion Palpation Institute & Movement Systems,
Cincinnati, Ohio, USA

Objective:   To review the case of a patient who suffered a cervical spine fracture-dislocation missed at a hospital emergency department.

Clinical Features:   A 77-year-old man involved in a motor vehicle accident was transported to a local emergency hospital where cervical spine x-ray films taken were reported as demonstrating no evidence of acute injury. The patient visited a chiropractic clinic 6 days later, where x-ray films were again obtained, finding that the patient sustained fractures of C5 and C6, as well as a bilateral facet dislocation at C5/C6. Computed tomography confirmed the fractures, and magnetic resonance imaging findings demonstrated cervical spinal cord compression and posterior spinal cord displacement.

Intervention and Outcome:   The patient was referred for preoperative medical evaluation. He underwent C5-6 closed reduction and anterior/posterior fusion surgery and was released without complication. Patient follow-up indicated full recovery with minimal neurologic symptoms.

Conclusion:   Cervical spine fracture-dislocations are often missed during standard radiographic examinations in emergency department settings. Chiropractors are encouraged to perform a comprehensive evaluation of patients presenting with cervical trauma even if they have had prior x-ray films reported as normal. Standard x-ray films taken at emergency department facilities are not entirely reliable for detecting or revealing cervical spine fracture-dislocations. This case stresses the importance of careful clinical assessment and imaging procedures on patients who have encountered cervical spine trauma.

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