Radiology Review

Ladder Becomes Stairway to Urgent Care

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Neck pain image

What is your impression?

A 30-year-old man presents to an urgent care clinic for evaluation of neck pain secondary to an injury he sustained earlier in the day. He was at a construction worksite, on a ladder, approximately eight to 10 feet above the ground. He went to step onto an adjacent ladder and missed. His chin and face struck one of the rungs, and his head went back. Amazingly, he was able to maintain his balance, holding onto the sides of the ladder, sliding down the front, and landing on his feet. He immediately began to experience neck pain, as well as numbness and tingling in both arms (worse on his left side). He was placed in a rigid collar upon arrival to the facility. Medical history is unremarkable except for tobacco use. Vital signs are normal. Physical exam demonstrates some neck pain within the paraspinous muscles. There is some mild midline tenderness within the cervical spine. Of note, the numbness and tingling seem to be worst in his index finger and thumb. You obtain a cervical spine radiograph; the lateral view is shown. What is your impression?


The radiograph shows a compression deformity of the C6 vertebral body. In addition, there is a displaced fracture fragment along the anterior superior endplate. Alignment is adequate, with no evidence of subluxation. The disc space of C6-7 also appears slightly distracted, suggesting possible acute injury.

Given the clinical and radiographic presentation, this patient warranted further workup. He was admitted for CT and MRI of the cervical spine, which demonstrated disc herniation at both the C5-6 and C6-7 levels, as well as interspinous ligament injury.

The patient subsequently underwent a two-level anterior cervical disc­ectomy and fusion. His symptoms resolved, and he was discharged home the next day.

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Patient Has No Complaints, But Family Is Concerned

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