Pathological Burst Fracture in the Cervical Spine
With Negative Red Flags: A Case Report

The Chiro.Org Blog

SOURCE:   J Can Chiropr Assoc. 2016 (Mar); 60 (1): 81–87

Jocelyn Cox, DC, Chris DeGraauw, DC FRCCSS(C), and
Erik Klein, DC

Department of Graduate Education and Research Program,
Canadian Memorial Chiropractic College,
6100 Leslie Street,
North York, ON, M2H 3J1

OBJECTIVE:   To report on a case of a pathological burst fracture in the cervical spine where typical core red flag tests failed to identify a significant lesion, and to remind chiropractors to be vigilant in the recognition of subtle signs and symptoms of disease processes.

CLINICAL FEATURES:   A 61-year-old man presented to a chiropractic clinic with neck pain that began earlier that morning. After a physical exam that was relatively unremarkable, imaging identified a burst fracture in the cervical spine.

INTERVENTION & OUTCOMES:   The patient was sent by ambulance to the hospital where he was diagnosed with multiple myeloma. No medical intervention was performed on the fracture.

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SUMMARY:   The patient’s initial physical examination was largely unremarkable, with an absence of clinical red flags. The screening tools were non-diagnostic. Pain with traction and the sudden onset of symptoms prompted further investigation with plain film imaging of the cervical spine. This identified a pathological burst fracture in the C4 vertebrae.

KEYWORDS:   burst fracture; chiropractic; red flags

From the FULL TEXT Article:


Chiropractors are manual therapists trained in the diagnosis and treatment of musculoskeletal conditions. In order to elicit an appropriate diagnosis, chiropractors rely heavily on the history the patient provides. This includes the mechanism of injury, temporal onset, aggravating and relieving factors, and psychosocial influences. The presence of serious pathology includes, but is not limited to:

(1) pain that is worse during rest versus activity,

(2) pain that is worsened at night or not relieved by any position,

(3) a poor response to conservative care including a lack of pain relief with prescribed bed rest, or

(4) poor success with comparable treatments. [1]

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