Radiology Review

Neck Pain With No Palpable Tenderness

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A 65-year-old man presents with neck pain following a fall. Earlier this evening, he says, he fell off his porch (approximately four feet in height) and hit the top/front of his head on the ground. He denies any loss of consciousness, adding that he only came in for evaluation at the urging of his family. The patient denies any extremity weakness or paresthesias. He also denies any significant medical history, although his sister, who has accompanied him, states that he drinks alcohol “regularly and heavily.” Physical examination reveals a man who appears much older than his stated age and is uncomfortable, but not in obvious distress. His vital signs are normal. He is currently wearing a hard cervical collar. There is no palpable tenderness posteriorly along his cervical spine. He is able to move all of his extremities well. His strength is good, and his sensation is intact. A lateral radiograph of the patient’s cervical spine is shown. What is your impression?



The image shows an acute fracture at the base of the odontoid with evidence of posterior displacement of the fracture fragment. Such fractures are typically unstable.

In addition, there is evidence of a fracture and subluxation at the C4/C5 level. However, given the degree of sclerosis and chronic changes present, this finding is likely an old one.

The patient was maintained in a collar on bedrest. Subsequently, he underwent odontoid pinning to stabilize the fractures.

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