Published online Nov 26, 2021. doi: 10.12998/wjcc.v9.i33.10369
Peer-review started: July 9, 2021
First decision: July 26, 2021
Revised: July 29, 2021
Accepted: September 10, 2021
Article in press: September 10, 2021
Published online: November 26, 2021
Missed or delayed diagnosis of cervical spine instability after acute trauma can have catastrophic consequences for the patient, resulting in severe neurological impairment. Currently, however, there is no consensus on the optimal strategy for diagnosing occult cervical spine instability. Thus, we present a case of occult cervical spine instability and provide a clinical algorithm to aid physicians in diagnosing occult instability of the cervical spine.
A 57-year-old man presented with cervical spine pain and inability to stand following a serious fall from a height of 2 m. No obvious vertebral fracture or dislocation was found at the time on standard lateral X-ray, computed tomo
MRI of cervical spine trauma patients should be carefully reviewed to detect disco-ligamentous injury, which will lead to further cervical spine instability. In patients with highly suspected cervical spine instability indicated on MRI, lateral X-ray under traction or after anesthesia and muscle relaxation needs to be performed to avoid missed diagnoses of occult cervical instability.
Core Tip: Currently, there is no consensus on the optimal strategy for diagnosing occult cervical spine instability. We present a case of occult cervical spine instability and provide a clinical algorithm for diagnosing occult instability of the cervical spine. In this clinical algorithm, we recommend bedside lateral X-ray under traction or lateral X-ray after anesthesia and muscle relaxation prior to surgery as an effective, safe, and efficient method for detecting highly suspected instability of the cervical spine. We believe that this clinical algorithm will aid physicians in preventing missed diagnoses of occult instability of the cervical spine.