Hyperextension trauma in the elderly: an easily overlooked spinal injury

The diagnosis of hyperextension injury to the cervical spinal cord after a fall is easily overlooked in the elderly. This is because the pattern of neurologic deficit, usually that of the 'central cord syndrome,' is complex and because no radiologic signs of trauma are present apart from changes of cervical spondylosis. The case history of a patient who had delayed onset of paralysis after a fall and in whom the correct diagnosis was initially overlooked is presented. In older patients hyperextension injuries may result in serious damage to the spinal cord due to preexisting weakness of the intervertebral discs, which are fragmented and fissured as a result of degeneration. In such patients, radiologic evidence of spondylosis and a posterior osteophyte at C4/C5 or C5/C6 often go unnoticed. This injury is usually caused by indirect cervical spine trauma resulting from head or face injury. A lateral X-ray view of the area with the patient supine is safe, quick, and inexpensive.