Cervical Spine Fracture Missed in the ER

Posted On: May 15, 2017

This is the eight case review of interesting cases from my past practice. I am Dr. David Johnson a chiropractor and physical therapist in Lake Bluff and Highland Park. I am the director of North Shore Spinal and Sports Rehabilitation. I have practiced chiropractic and physical therapy on Chicago’s North Shore for almost 30 years. I started as a chiropractor in Lake Forest, Illinois in 1987. I integrated physical therapy into my practice in 1990.

This is case of a gentleman in his mid forties who fell over the handlebars of his bike headfirst into a boulevard. He explained he hit his brakes and the front brake were tighter than the rear brakes. He fortunately was wearing a helmet when he went into a grassy boulevard. When his head hit he heard his neck make a “crack” and he had immediately neck pain.

He went to the ER and he was examined and x-rays were taking. He was told he had no fracture and that he just has “whiplash.” He was given a pain medication, a muscle relaxant and told to follow with his medical doctor.

He followed with me instead. I took the history and did my exam. He had painful limited ranges of motion with extension and right rotation. He had myofascial splinting (muscle spasm) of the right cervical paraspinal musculature. Neurologically he was intact. When I palpated deeply over the area of the vertebrae he was exquisitely tender at the area of the right C6/C7 facet. He actually turned very pale and pulled away from me at the time.

I told him I didn’t think he had a whiplash injury and that I am concerned that something might be fracture in his neck.

He was angry with me and demanded I just adjust his neck. I refused and told him to get me the x-rays. I said in the mean time I can put your on electric stimulation for pain relief and start icing the area. He agreed and said he would get the x-rays.

He came back two days later and he had the x rays with him. I examined the films and couldn’t find the fracture. I told him I still wasn’t convinced. He was frustrated and I said please let me take the films to a radiologist for a second opinion. He agreed but told me he was going to an orthopedic surgeon to get another opinion. I said hat was fine.

He went to the surgeon the next day. I took the x-rays to the radiologist the morning after that. The surgeon said he was fine and started him doing neck rotation exercises. The chiropractic radiologist when looking over the films spotted a suspicious area. The base of the right C7 facet had a crack and the facet was bent forward. I called the patient and told him he had a fracture and stop doing the range of motion exercises. He said gladly because he was staring o get pain down his arm.

I got him in and examined him. He now had developed neurologic findings. He had weakness of his right triceps, loss of the triceps deep tendon reflex and loss of sensation over he the right thumbs web space. All of which started as the result the ill-advised range of motion exercises.

I placed him in a hard cervical collar. Advised him that it is a stable fracture of his cervical spine. He needed to limit his neck movement with the collar for at least eight weeks. I sent him for a bone scan to confirm the fracture identified by the second radiologist given the opposite opinion of the hospital’s radiologist and the orthopedic surgeon. The bone scan was positive confirming the fracture. We worked on rehabilitating his triceps and eventually into neck ranges of motion when the fracture had healed. He ultimately recovered fully.

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