- Traumatisme du rachis cervical symptôme diagnostic
- Fracture du rachis cervical pdf
- Pathological burst fracture in the cervical spine with negative red flags: a case report
- Avulsion du listel marginal antérieur du rachis cervical
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- Les fractures du rachis dorsal et lombaire
- 8. Traumatismes du rachis dorso-lombaire
Language: English French. To report on a case of a pathological burst fracture in the cervical spine where typical core red flag tests failed to identify a significant lesion, and to remind chiropractors to be vigilant in the recognition of subtle signs and symptoms of disease processes.
A year-old man presented to a chiropractic clinic with neck pain that began earlier that morning. After a physical exam that was relatively unremarkable, imaging identified a burst fracture in the cervical spine. The patient was sent by ambulance to the hospital where he was diagnosed with multiple myeloma.
No medical intervention was performed on the fracture. The screening tools were non-diagnostic. Pain with traction and the sudden onset of symptoms prompted further investigation with plain film imaging of the cervical spine.
This identified a pathological burst fracture in the C4 vertebrae. Chiropractors are manual therapists trained in the diagnosis and treatment of musculoskeletal conditions.
In order to elicit an appropriate diagnosis, chiropractors rely heavily on the history the patient provides. This includes the mechanism of injury, temporal onset, aggravating and relieving factors, and psychosocial influences. The presence of serious pathology includes, but is not limited to: 1 pain that is worse during rest versus activity, 2 pain that is worsened at night or not relieved by any position, 3 a poor response to conservative care including a lack of pain relief with prescribed bed rest, or 4 poor success with comparable treatments.
Traumatisme du rachis cervical symptôme diagnostic
For chiropractors, radiological plain film imaging is used to assess bone health and to screen for underlying pathology. If there is any indication for further work-up, such as blood work or advanced imaging, inter-professional collaboration with other health care professionals is crucial.
The objective of this case report is two-fold.
The first is to highlight the need to be vigilant in recognizing and responding to subtle signs and symptoms of disease processes. The second is to remind clinicians to rely on all of their assessment tools, including radiographic imaging, if orthopaedic tests are of limited value.
A year-old retired male presented to a chiropractic clinic in the mid-morning, complaining of dull, achy cervicothoracic discomfort in the left upper scapular area. He came to the clinic wearing a soft cervical collar.
There was an immediate reaction including sweating and dizziness, lasting five minutes. Slight pain relief was achieved by taking two Tylenol 3s and pressing his occiput against the edge of the bed. Coughing aggravated the pain in the mid-cervical spine. Slight weakness was reported when picking up a glass of water with his left hand; however, this was not consistent throughout the morning. Otherwise, there were no neurological symptoms described in the upper limb, lower limb, or cranium.
His past health history was unremarkable. The patient described having a cold for approximately three weeks in advance of the date of presentation, but felt well on that day. Approximately fifteen years previously, he had a mole removed from his nose that was determined to be pre-cancerous.
The patient had an active lifestyle including a healthy diet, regular exercise, no smoking, and social alcohol consumption.
Fracture du rachis cervical pdf
He was pre-diabetic and over-weight. This was his first chiropractic visit. A post-history differential list included compression fracture, grade two mechanical neck pain, and strain of the cervicothoracic musculature. Prior to the physical examination, the patient removed the collar himself and went through active ranges of motion that was painless with only a mild limitation at end range globally. A full neurological examination of the upper and lower limb was intact, and bilaterally symmetrical.
Valsalva and spinal percussion tests were negative. There was mild muscle spasm in the trapezius and cervical paraspinals bilaterally. Axial compression of 2—3 lbs of pressure did not contribute to or alleviate his symptoms. Cervical traction was painful.
Pathological burst fracture in the cervical spine with negative red flags: a case report
The examination was tiring for the patient, however, no motor weakness was found. The physical exam was unable to rule out compression fracture. The patient replaced his collar and was sent for cervical spine films to a chiropractic radiologist. The chiropractic radiologist conferred with the referring chiropractor, and emergency measures were taken including re-collaring the patient and having him transferred by ambulance to the hospital.
The chiropractic radiologist then conferred with the radiologist at the hospital and was able to provide collaborated evaluation.
Avulsion du listel marginal antérieur du rachis cervical
Anterior Posterior Cervical Spine: Decreased vertebral body height of C4 arrow , moderate degenerative joint disease of the Lushka and facet joints at C, C, and generalized osteopenia, deviation of the tracheal air shadow to the right.
Lateral Cervical Spine Plain Film Image: Severe pathologic compression fracture of C4 vertebral body, increase in the AP dimension arrow with focal anterior displacement of the retropharyngeal soft tissue, posterior displacement of the posterior wall of the vertebral body compromising the spinal canal, moderate to severe generalized osteopenia, with a decrease in cervical lordosis.
Following advanced imaging it was determined the patient had multiple myeloma in his cervical spine, thoracic spine and ribs. At the hospital he was put into a hard collar and developed hard radicular signs and pneumonia by nightfall. Due to the complexity of the lesion and the pneumonia, the burst vertebra was unable to be managed operatively at that time. This patient presented with acute neck pain without radiation after waking up that morning.
The physical exam was surprisingly non-conducive, given the diagnosis. The significant physical exam findings were increased pain with traction despite painless range of motion, negative spinous percussion test, and a normal neurological exam.
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It is pertinent to recognize there is limited strength in many of the tests that are presented, including differentiating a fracture of the cervical spine. Spinal percussion has no evidence for use in the cervical spine. In the lumbar spine, there are mixed reviews as to whether spinal percussion has diagnostic significance. In one study by Langdon in , spinal percussion was found to be diagnostic for upper lumbar osteoporotic compression fractures with a sensitivity of Additional tests used in this case were valsalva, axial distraction, and axial compression.
These tests are used primarily to differentiate radiculopathy from a central cord pressure whether from space occupying lesion or disc herniation.
Les fractures du rachis dorsal et lombaire
Overall, the tests applied in this case tend to have low sensitivity, and moderate to high specificity when testing for cord compression to the cervical spine. A burst fracture is a specific form of compression fracture that requires considerable forces of axial compression and flexion in healthy bone.
In some cases with variable history or unclear mechanisms of injury, it is difficult to discern whether or not imaging is indicated for the patient. Screening tools and guidelines have been developed to determine whether or not radiographic imaging is required.
Multiple myeloma MM is the most common primary malignant spinal tumour in adults.
Blood work tends to have a serum M-protein spike of IgG, Bence Jones proteinuria, hypercalcemia and hyperuricemia. Two additional case reports in the last decade describe the presence of cervical spine pathological burst fracture in a medical setting by specialists. This should affect the decision making of all manual therapy practitioners when considering differentials of rare but serious pathology as they may not possess traditional history red flags, nor possible signs on examination. A year-old male presented to a chiropractic clinic for management of acute neck pain.
There were no red flags in the history. The physical exam identified traction was aggravating, but was otherwise non-conducive. This case should serve as a reminder that in some circumstances, orthopaedic tests may be of limited clinical value.
Practitioners need to be diligent in their clinical assessment of patients to be aware of subtle signs of disease processes. It also serves as a reminder to clinicians that these rare cases do present to our offices and radiographic intervention is still the diagnostic tool of choice to confirm a pathological fracture diagnosis.
Informed consent was obtained from the patient for the publication of this manuscript.
8. Traumatismes du rachis dorso-lombaire
There was no financial support provided for this document. National Center for Biotechnology Information , U. J Can Chiropr Assoc. Author information Copyright and License information Disclaimer. This article has been cited by other articles in PMC. Abstract Objective: To report on a case of a pathological burst fracture in the cervical spine where typical core red flag tests failed to identify a significant lesion, and to remind chiropractors to be vigilant in the recognition of subtle signs and symptoms of disease processes.
Clinical Features: A year-old man presented to a chiropractic clinic with neck pain that began earlier that morning. Keywords: chiropractic, burst fracture, red flags.
Introduction Chiropractors are manual therapists trained in the diagnosis and treatment of musculoskeletal conditions. Case Presentation A year-old retired male presented to a chiropractic clinic in the mid-morning, complaining of dull, achy cervicothoracic discomfort in the left upper scapular area.
Open in a separate window. Figure 1. Figure 2.
Figure 3. Discussion This patient presented with acute neck pain without radiation after waking up that morning. Figure 4. Summary A year-old male presented to a chiropractic clinic for management of acute neck pain.
Footnotes Informed consent was obtained from the patient for the publication of this manuscript. References: 1. Medical screening for red flags in the diagnosis and management of musculoskeletal spine pain. Pain Practice. Hampton JR, et al. Relative contributions of history-taking, physical examination, and laboratory investigation to diagnosis and management of medical outpatients.
Kehoe R, et al. Comparing self-reported and physician-reported medical history. Am J Epidemiol. Keitz SA.