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Compression Fracture of Cervical Spine

Piran Aliabadi, MD
B Leonard Holman, MD

November 8, 1995

Presentation

A 25-year-old woman presents with neck pain after a fall. The neck was placed in a cervical collar and the patient was transferred to the emergency department. The physical examination, including the neurologic examination, is normal except for neck tenderness.

Imaging Findings

Lateral Radiograph of Cervical Spine with Collar
Lateral Radiograph with Shoulder traction
AP Radiograph with Shoulder Traction
CT of the lower cervical spine

On the first plain radiograph of the cervical spine, the upper six cervical vertebrae appear normal. C7 is not visible.

On lateral radiograph of the cervical spine with shoulder traction, the C7 vertebra is clearly visible. An anteroposterior (AP) view of the cervical spine is also obtained. The lateral radiograph shows mild compression (anterior wedging) of the C7 vertebra (black arrows) with prevertebral soft tissue swelling anterior to C7 as demonstrated by fat pad displacement (white arrow). The AP film is normal.

A complete cervical spine radiograph series is performed and does not show other abnormalities. Lateral flexion and extension views also do not show abnormal motion.

There is a small area of soft tissue swelling (hematoma) anterior to the C7 vertebra (arrow). The compression fracture which was seen on the plain film is not detected by CT and no other abnormality is seen.

Diagnosis

Anterior wedging of C7 vertebra

Discussion

The first plain film study for evaluation of the cervical spine in a patient after trauma is a lateral view in the cervical collar. All of the cervical vertebrae must be seen clearly. If the lower cervical vetebrae are not included on the film, a repeat lateral view with shoulder traction must be performed to clearly visualize the entire cervical vertebrae. If the C7 vertebra is not clearly seen, a repeat lateral view using other means such as Swimmer's view (if the patient can move the arm), or trauma oblique views must be obtained to clearly see the entire cervical vertebrae. Additional imaging depends on the clinical examination and plain film findings. If the clinical suspicion is high for cervical fracture or other injury or if the plain radiographs are abnormal or suspicious, obtain a CT for the best definition of the osseous architecture.

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