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Chiropractic Research Review

Imaging for Cervical Fractures: Avoiding Misdiagnosis

Fractures in the upper cervical spine are somewhat rare, although most doctors are familiar with the burst fracture - a fracture of C1 in two locations in the anterior and posterior arches. These fractures are usually caused by axial trauma to the head.

This case report illustrates the importance of careful radiographic reading technique of cervical trauma patients.

A man fell off of a roof and was immediately taken to an emergency room for evaluation; radiographs were read as normal and the man was discharged. He then sought care from a physiotherapist and also tried various routes of care in other facilities. Several times his radiographs were stated to be normal. Three months after the accident, the man presented to a chiropractor who took a new anteroposterior open mouth (APOM) cervical view, suspecting a cervical fracture. A C1 burst fracture was noted, and the man was promptly referred for surgery.

Burst fractures usually demonstrate lateral displacement of the lateral masses of C1 when viewed on the APOM radiograph. Retropharyngeal soft tissue swelling significant enough to be detected on x-ray may not present for 6 hours following the trauma. Clinical signs include neck pain and stiffness, and typically headache, due to the nature of the trauma. Advanced imaging techniques such as CT scan and MRI are also discussed.

Regelink GA, de Zoete A. A missed Jefferson fracture in chiropractic practice. Journal of Manipulative and Physiological Therapeutics 2001:24(3), pp210-213.
Reprints: Tel: (800) 325-4177 (ext. 4350); Fax: (314) 432-1380

Chiropractic Research Review

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