A 69-year-old man is admitted by the trauma service for observation after sustaining a ground-level fall. He was intoxicated at the time, and upon arrival at the emergency center, he expressed generalized complaints of soreness, especially on the left side of his face. His vital signs are stable, and he denies any significant medical history.
Physical exam reveals a small contusion on his forehead, with some other abrasions and moderate soft-tissue swelling around his left eye. Otherwise, his exam is unremarkable. He denies any neck or back pain and is neurologically intact. A flexion view of the cervical spine is shown.
Answer
The radiograph demonstrates significant anterior translation (12 to 13 mm) of the odontoid and ring of C1 in relation to the body of C2. This appears to cause significant stenosis of the central canal between the posterior ring of C1 and the posterior body of C2.
A mild retrolisthesis between C3 and C4 is also present, as is generalized cervical spondylosis. As it turns out, this patient had a chronic nonunion between C1 and C2—an unstable injury that will require stabilization when feasible.
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