Er. Crowther, MISSED CERVICAL-SPINE FRACTURES - THE IMPORTANCE OF REVIEWING RADIOGRAPHS IN CHIROPRACTIC PRACTICE, Journal of manipulative and physiological therapeutics, 18(1), 1995, pp. 29-33
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.