Cervical Spine Fracture With Vertebral Artery Dissection

Area of Science:

• Orthopedics
• Neurology
• Radiology

Background:

• Direct-access physical therapy allows patients to seek care without physician referral.
• The Canadian C-spine rule aids clinicians in identifying high-risk patients for cervical spine radiography.
• Vertebral artery dissection is a potential cause of neck pain and neurological deficits.

Observation:

• A 51-year-old male surfer presented with 5 days of neck pain following a fall in shallow water.
• The patient's mechanism of injury met the criteria for a "dangerous mechanism of injury" on the Canadian C-spine rule.
• Initial cervical spine radiographs were concerning for a significant injury.

Findings:

• Computed tomography (CT) imaging suggested vertebral artery dissection.
• Magnetic resonance imaging (MRI) confirmed the diagnosis of vertebral artery dissection.
• The patient's presentation underscores a rare but serious complication of blunt neck trauma.

Implications:

• Physical therapists in direct-access settings must be vigilant for "red flag" symptoms and signs.
• Radiographic imaging, including CT and MRI, plays a crucial role in diagnosing vertebral artery dissection.
• Early recognition and diagnosis of vertebral artery dissection are critical for appropriate management and to prevent potential complications such as stroke.