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Neck Pain After Trauma


Consult Page

60 year old male pedestrian struck, found to have C1 burst fracture

Initial Imaging

Figure 7.1, Axial views of a CT c-spine show a posterior arch fracture with right posterolateral C1 lateral mass displacement (A) and an anterior arch fracture (B). Sagittal view demonstrates the posterior and anterior displacement of the right lateral mass burst fracture (C).

Figure 7.2, Coronal view of a CT c-spine demonstrates 8 mm of overhang of the right C1 lateral mass on the C2 lateral mass (concern for TAL injury per the Rule of Spence).

Walking Thoughts

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    What is the mechanism of injury?

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    Does the patient have any neurological deficits?

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    What is the exact fracture pattern on imaging? Is this a stable or unstable fracture?

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    Are there any other injuries, including other spinal fractures?

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    Is a hard cervical collar in place?

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    Does the patient need an MRI to evaluate for ligamentous injury or epidural hematoma?

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    Is there concern for vertebral artery injury and has a CT angiogram (CTA) been obtained to evaluate the vasculature?

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    Is the patient a surgical candidate? Is he on any anticoagulant or antiplatelet agents?

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