Fracture of a lamina in the cervical spine

To present an uncommon case of an isolated lamina fracture in the cervical spine found by taking stress films when a routine cervical series failed to demonstrate it.

A 63-yr-old male was seen after suffering from mild neck pain and stiffness of 4 days' duration after a car accident. A review of emergency room X-rays demonstrated a small fragment of bone adjacent to the anterior superior end-plate of C6. Flexion/extension stress views were then done that demonstrated anterior slippage of C5 on C6 during flexion, and a cervical lamina fracture of C5 was diagnosed and confirmed with a subsequent MRI.

This patient was treated with specific spinal mobilization for motion restrictions above and below the fracture site, avoiding stress on the C4-6 motor units. Soft tissue, gentle manual cervical traction and patient education on avoiding stress to the cervical spine were given. Resolution of neck pain and stiffness was achieved in three visits, and 6-wk follow-up radiographs demonstrated healing and increased stability at the fracture site.

A significant percentage of the average chiropractor's practice will involve the management of cervical spine injuries from motor vehicle accidents. The inclusion of stress films in the regular cervical series can reduce the possibility of missing an occult fracture or instability. When neurological complications are absent, such cases can be managed conservatively with the judicious application of spinal manipulative and adjunctive procedures.