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Trauma Case Imaging

Cliff Tao DC, DACBR

Orange County, California
(Contact Email)

Published:
Journal of the Academy of Chiropractic Orthopedists
September 2015, Volume 12, Issue 3

This is an Open Access article which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The article copyright belongs to Tao and the Academy of Chiropractic Orthopedists and is available at: http://www.dcorthoacademy.org. © 2015 Tao and the Academy of Chiropractic Orthopedists.

This is a 52 year old male with severe neck pain, right greater than left after flexion/extension/rotation injury in a recent motor vehicle accident. Severe loss of active and passive ranges of motion. No reported loss of consciousness. No neurologic findings. Hospital x-rays of the cervical spine including oblique views were brought in by the patient for your evaluation. Image quality is suboptimal because of soft neck collar. What are the radiographic findings?

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  1. Right C6 facet fracture.
  2. Very mild degenerated disc and uncovertebral joints at C5/6, producing bilateral neuroforaminal stenosis.
  3. Mild posterior spondylosis at C4/5 and C5/6, probably compatible with disc herniation.
  4. Hypolordosis.
  5. Pronounced head rotation on the lateral view, probably positional.

This case demonstrates the importance of taking multiple views of a body region in trauma cases. The facet fracture is seen only visible on the right anterior oblique view. This is not a common fracture, but it is commonly missed (1). The patient’s severe loss of ROM precluded flexion/extension views, but generally those would also be an appropriate addition to the standard cervical spine x-ray series.

The treatment of unilateral cervical facet fracture is controversial, and generally either involves non-operative treatment with immobilization, or fusion. Magnetic resonance imaging and/or computed tomography may be useful, but is generally not clinically indicated.

1. Kalayci M Cagavi F Açikgöz B. Unilateral cervical facet fracture: presentation of two cases and literature review. Spinal Cord 42(8):466-72, 2004.