Summary
Occult injuries of the cervical spine in certain patients may lead to misdiagnosis or delayed diagnosis and treatment. The authors present a patient with an occult cervical spinal fracture-dislocation and review the literature. A 37 year-old male was involved in a motor vehicle accident. At his admission, the patient was alert and denied any pain in the cervical region, as well as neurologic symptoms. Physical examination revealed painless range of motion of his neck and no sensory or motor deficits. Plain radiographs of the cervical spine showed unilateral dislocation of C4 on C5 vertebra with fracture of the left facet of C5 vertebra. Computed tomography scanning showed no neural compression. Operative reduction, stabilization and arthrodesis of the spine were advised, but the patient refused operative treatment. One year after his initial injury, the patient presented with torticollis and no neurologic symptoms.
Résumé
Des traumatismes méconnus du rachis cervical peuvent conduire à des diagnostics erronés ou entraîner des retards diagnostiques et thérapeutiques. Les auteurs rapportent le cas d'un patient présentant une fracture-luxation méconnue et font à ce propos une analyse de la littérature. Cet homme de 37 ans avait été victime d'un accident de circulation automobile. A l'admission il était alerte et ne se plaignait d'aucune douleur cervicale ni d'aucun signe neurologique. L'examen clinique montrait une mobilité cervicale normale et indolore et ne retrouvai aucun déficit sensitivo-moteur. Les radiographies standards devaient cependant montrer une fracture-luxation de C4 sur C5 avec une fracture articulaire gauche de C5. La scanographie ne révéla aucune souffrance neurologique. La réduction chirurgicale, la stabilisation avec arthrodèse fut proposée mais le patient refusa tout traitement opératoire. Une année après l'accident le patient fut revu pour un torticolis sans signes neurologiques.
Similar content being viewed by others
References
Babcock JL (1976) Cervical spine injuries. Arch Surg 111: 646–651
Bachulis BL, Long WB, Hynes CD, et al (1987) Clinical indications for cervical spine radiographs in the traumatized patient. Am J Surg 153: 473–477
Bertolomi CN, Kaban LB (1982) Chin trauma: A clue to associ-ated mandibular and cervical spine injury. Oral Surg 53: 112–126
Blanda M, Dunham CM, Fonatanarosa P, et al (1989) Transient neurologic deficits without cervical spine fracture 0r dislocation following blunt trauma. Ann Emerg Med 18(4): 452 (abstr)
Bohlman HIT (1979) Acute fractures and dislocation of the cer vical spine. J Bone Joint Surg 61A: 1119–1142
Bresler MJ, Rich GH (1982) Occult cervical spine fracture in an ambulatory patient. Ann Emerg Med 11: 440–442
Bresler MJ, Rich GH (1983) Just a little neck pain. Emerg Med 15: 92–93
Hachen JH (1981) Computed tomography of the spine and spinal cord; limitations and applications. Paraplegia 19:155–163
Haines JD Jr (1986) Occult cervical spine fractures. Postgrad Med 80: 73–74,77
Handel SF, Lee YY (1981) Computed tomography of spinal fractures. Radiol Clin North Am 19: 68–89
Jacobs LM, Schwartz R (1986) Prospective analysis 0f acute cervical spine injury: A methodology t0 predict injury. Ann Emert Med 15: 44–49
Lieberman JF, Maull KI (1988) Occult unstable cervical spine injury. J Tenn Med Assoc 81: 243–244
Levine AM, Edwards CC (1986) Complications in the treatrnent of acute spinal injury. Ortho Clin N Am 17: 183–203
Mace SE (1990) Injuries to the cervical spine in the presence 0f congenital anomalies. Complications Orthop 5: 66–72
Mace SE (1991) Unstable occult cervical spine fracture. Ann Emerg Med 20: 1373–1375
Maull KI, Sachatello CR (1977) Avoiding a pitfall in resuscitation The painless cervical fracture. South Med J 70: 477–478
McCabe JB, Angelos MG (1984) Injury t0 the head and face in patients with cervical spine injury. Am J Emerg Med 2: 333–335
Meyer PR, Sullivan DE (1984) Injuries to the spine. Emerg Med Cl in North Am 2:313–329
Nichols CG, Young DH, Schiller WR (1987) Evaluation 0f cervi-cothoracic junction injury. Ann Emerg Med 16:640–642
Ogden W, Dunn JD (1986) Cervical radiographic evaluation following blunt trauma. Ann Emerg Med 15:604–605
Reid DC, Henderson R, Sabol L, et al (1987) Etiology and clinical course 0f missed spine fractures. J Trauma 27:980–986
Roberge RG (May 1993) Unstable occult cervical-spine fracture. Letter to the editor. Ann Emerg Med 22:5 p. 868
Ross SE, O'Malley KF, Delong WG, et al (1987) Clinical predictors 0f cervical spine injury (CSI) in blunt high energy transfer injuries (BHETI). Ann Emerg Med 16:498 (abstr)
Streitwieser DR, Knopp R, Wales LR, et al (1983) Accuracy 0f standard radiographic views in detecting cervical spine fractures. Ann Emerg Med 12: 538–542
Swetnam R (1985) Cervical spine injuries. In Tintinalli JW, Rothstein RJ, Krome RL (eds): Emergency Medicine: A Comprehensive Study Guide. New York, NY, McGraw-Hill, pp 801–806
Thambyrajah K (1972) Fractures 0f the cervical spine with minimal or no symptoms. Med J Malaysia 26: 244–249
Walter J, Doris PR, Shaffer MA (1984) Clinical presentation 0f patients with acute cervical spine injury. Ann Emerg Med 13: 512–515
Williams CF, Bernstein TW, Jelenko C (1981) Essentiality 0f the lateral cervical spine radiograph. Ann Emerg Med 10: 198–204
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Korres, D.S., Papagelopoulos, P.J., Petrou, H.G. et al. Occult fracture-dislocation of the cervical spine. Eur J Orthop Surg Traumatol 9, 195–199 (1999). https://doi.org/10.1007/BF00542592
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/BF00542592