Occult cervical spine fracture in an ambulatory patients

Significant injury to the cervical spine many not be obvious in patients whose mental status is decreased. We present the case of a fully conscious, ambulatory patient with no complaint of neck pain and only mild tenderness on examination who nevertheless had sustained an unstable fracture-dislocation of the cervical spine. Following surgery, the patient recovered without permanent neurologic sequelae. Criteria are suggested for ordering radiographic studies of the cervical spine for victims of trauma.