MISSED CERVICAL-SPINE FRACTURES - THE IMPORTANCE OF REVIEWING RADIOGRAPHS IN CHIROPRACTIC PRACTICE

Objective: This report reviews the case of a missed cervical spine fra cture in a patient presenting for chiropractic manipulative therapy. A review of the literature suggests that radiographic examinations perf ormed in emergency care settings following cervical spine trauma are o ften incomplete for the purposes of screening for contraindications to manipulative therapy. Sensitivity of the standard radiographic cervic al spine series for detecting fracture suggest an unacceptable high le vel of false negatives and chiropractors are cautioned to requisition and review all X-rays and ensure a complete radiographic series before initiating treatment. Clinical Features: A 65-yr-old woman presented to a chiropractic office for examination and treatment of cervical spi ne injuries suffered in a deceleration type motor vehicle accident. Ho spital X-rays were reported normal for fracture. Subsequent radiograph s of the cervical spine demonstrated the presence of a posterior arch fracture of C2. Intervention and Outcome: The patient was referred for further imaging and was treated conservatively with bracing of the ce rvical spine. Follow-up 5 months later demonstrated substantial recove ry with some residual stiffness and headache. Conclusion: Radiographs taken at emergency care settings are often incomplete for the purposes of screening for contraindications to manipulation. This case demonst rates that chiropractors should be extremely cautious in initiating ma nipulative therapy in those patients having sustained previous cervica l spine trauma and who have had prior X-rays that have been reported n ormal.