Misdiagnosed bilateral C5-C6 dislocation causing cervical spine instability: a case report

Abstract

IntroductionThe diagnosis of cervical spine injuries remains a significant problem in many blunt trauma patients. Correct and early diagnosis of these injuries is imperative as delayed or missed diagnoses result in increased morbidity and mortality.Case presentationA 57-year-old Caucasian woman presented with a misdiagnosed bilateral C5-C6 dislocation one month after a fall and head injury, without clearance of the cervical spine in her previous visits to two physicians and having already started physiotherapy sessions, despite the presence of pain in the clinical examination. Dislocation was treated with open reduction and spinal fusion with posterior instrumentation 4 weeks post-trauma.ConclusionsEvery physician should be highly suspicious of cervical spine injury in blunt trauma patients with positive clinical examination and include radiologic studies in his screening modality. Physiotherapy sessions should under no circumstances be started in the presence of underlying spine injury.

Clinical Efficacy of Anterior Partial Corpectomy and Titanium Mesh Fusion and Internal Fixation for Treatment of Old Fracture Dislocation of the Lower Cervical Spine

“…Early treatment of cervical spine injuries is beneficial for functional recovery and avoidance of neurological deterioration [ 2 ]. Injury of the cervical spine over 3 weeks old is known as an old injury.…”

Delayed or Missed Diagnosis of Cervical Instability after Traumatic Injury: Usefulness of Dynamic Flexion and Extension Radiographs

“…The patients with cervical spine injury presenting with neck pain require radiological examination, even if the neurological examination shows normal condition 2) . In a disco-ligamentous injury, 30% of patients with ligamentous disruption displayed a negative result on static radiographies and CT scan, and it was identified by subsequent MR imaging 10) .…”

“…When adequate flexion and extension motions are possible, dynamic flexion and extension radiographies for the evaluation of cervical instability are associated with a very low false-negative rate 2 4) . Some authors have recommended the average range of motion in patients judged to have adequate motion was 40.6 degrees (range, 23-58 degrees) 12) .…”

“…Some authors have recommended the average range of motion in patients judged to have adequate motion was 40.6 degrees (range, 23-58 degrees) 12) . However, because 30% of cervical trauma patients have a limitation to flex and extend due to acute neck pain following an accident, the incidence of positive results of dynamic flexion and extension radiographies in emergency rooms is very low(0.34%) 2 4 12) . These patients may have an increased risk of disco-ligamentous injury, and further imaging tools might be suggested 2 4) .…”

“…However, because 30% of cervical trauma patients have a limitation to flex and extend due to acute neck pain following an accident, the incidence of positive results of dynamic flexion and extension radiographies in emergency rooms is very low(0.34%) 2 4 12) . These patients may have an increased risk of disco-ligamentous injury, and further imaging tools might be suggested 2 4) . Fortunately, in our cases, cervical instability could be detected under insufficient motion range (range, 10.4-45.4 degrees) and even in the early period following the accident.…”