The purpose of this study is to describe the evaluation and management of a surfer who presented with concussion-like symptoms and was eventually diagnosed with an unstable cervical spine fracture.

A young man presented to a chiropractic clinic 5 weeks after a surfing injury. He had mild lower cervical spine pain and complaints of cognitive disturbance. He was previously evaluated by his primary care provider who diagnosed cervical sprain and strain injuries. There was no prior imaging or follow-up concussion management.

After a history, exams were performed of the cervical spine, thoracic spine, shoulder, and head, including a modified Sport Concussion Assessment Tool, Third Edition, concussion evaluation. Cervical spine radiographs were taken, which demonstrated a right C6 pillar fracture grade 2 anterior spondylolisthesis. These findings were confirmed with a CT scan. The patient was referred to an orthopedic spine specialist for further consultation, which resulted in cervical fusion of the C6/7 motor unit.

The use of clinical guidelines for head and neck injury assisted in the appropriate management of this patient with cervical spine injury presenting with concussion symptoms.