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Pathological cervical fracture after spinal manipulation in a pregnant patient
Alfred Schmitz1, Goetz Lutterbey, Lars von Engelhardt
1Department of Orthopaedic Surgery, University of Bonn, Germany. a.schmitz@uni-bonn.de
Objective:
To present the rare case of a displaced odontoid fracture after manipulative treatment.
Clinical Features:
A 37-year-old, 15-week pregnant patient was referred with acute neck pain and a diffuse paravertebral swelling that started after cervical manipulation performed by her general medical practitioner 5 days before. Because of pregnancy, a cervical spine radiographic series was not obtained before treatment. Magnetic resonance imaging revealed a displaced odontoid fracture associated with a pathological process in the vertebral body of C2 and a paravertebral hematoma on the left side from C2 to C4.
Intervention And Outcome:
After initial halo vest immobilization, an anterior-posterior fusion of C1-C2 was performed. The histological analysis showed features of an aneurysmal bone cyst. The patient was discharged and had an undisturbed pregnancy and was without any neurological complications.
Conclusions:
Because of the weakening lesion in C2, the spinal manipulation most likely caused the displaced odontoid fracture. Special imaging should be performed, preferably with magnetic resonance imaging, when a patient experiences significant new symptoms after cervical manipulation.
