You are called to the emergency room to evaluate a 26-year-old man who presents with neck pain secondary to a motor vehicle crash that occurred two days ago. The patient was an unrestrained rear-seat passenger in a vehicle that hit a telephone pole. The patient does not remember striking his head, just getting “jostled around.” He denies loss of consciousness. He has mild neck discomfort and denies any extremity weakness or numbness.
His medical history is unremarkable. Vital signs are normal. Physical exam overall is normal, with mild tenderness to palpation in the back of the neck. Examination of the extremities shows no motor or sensory deficits.
Radiograph of the cervical spine is obtained and shown.
Answer
The radiograph demonstrates a mild to moderate compression fracture of the C5 superior endplate. It appears to be age-indeterminate. Due to the abnormal radiographic findings and the patient’s symptoms, CT of the cervical spine had already been ordered. It subsequently was read as a mild compression fracture of C5, likely old.
The mechanism of injury and the patient’s persistent pain prompted an order for an MRI of the cervical spine. It demonstrated marrow edema consistent with an acute fracture. The patient was treated with a rigid cervical collar, and outpatient follow-up was arranged.
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