Long-standing axis odontoid fracture in patient presenting with acute low back pain |
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| Institution: | 1. Instituto de Ciencia de Materiales de Madrid. CSIC. C/ Sor Juana Inés de la cruz, 3. Madrid, 28049, Spain;2. Departamento de Química inorgánica, Universidad Autónoma de Madrid, Cantoblanco, Madrid 28049, Spain;3. Instituto de Química Orgánica General. CSIC. C/ Juan de la Cierva, 3 Madrid 28006, Spain;1. The College of New Jersey, United States;2. University of Pittsburgh, United States;3. Washington University, United States;1. University of Minnesota, Program in Occupational Therapy, 300 University Square, 111 South Broadway, Rochester, MN 55904, USA;2. University Orthopaedics Therapy Center, Fairview, 2450 Riverside Ave., Suite R102, Minneapolis, MN 55454, USA;3. University of Minnesota, Department of Orthopaedic Surgery, 2450 Riverside Ave. South, Suite 200, Minneapolis, MN 55454, USA;4. Mayo Clinic, Department of Orthopedic Surgery, 200 First St. SW, Rochester, MN 55905, USA;1. Departments of Internal and Experimental Vascular Medicine, Amsterdam University Medical Centers, Location AMC, Amsterdam, the Netherlands;2. Department of Surgery, Spaarne Hospital, Hoofddorp, the Netherlands;3. Systems and Synthetic Biology, Department of Biology and Biological Engineering, Chalmers University of Technology, Gothenburg, Sweden;4. Wallenberg Laboratory, Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden;5. Department of Pathology, UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands;6. Laboratory for Molecular Pharmacology, Department of Neuroscience and Pharmacology, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark;7. Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Heath and Medical Sciences, University of Copenhagen, Copenhagen, Denmark;8. Region Västra Götaland, Sahlgrenska University Hospital, Department of Clinical Physiology, Gothenburg, Sweden;1. Department of Obstetrics and Gynaecology, Royal College of Surgeons in Ireland, Rotunda Hospital, Dublin, Ireland;2. Department of Neonatology, Royal College of Surgeons in Ireland, Rotunda Hospital, Dublin, Ireland;3. Children’s Health Ireland at Crumlin, Dublin, Ireland |
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| Abstract: | Objective:To present the case of a patient affending for chiropractic care with acute low back pain. Incidentally, a previously unknown long-standing axis odontoid fracture was diagnosed, which resulted in a referral for neurosurgical management.Clinical features:A 63-year-old man presented for chiropractic care with a chief complaint of severe acute low back pain. His examination revealed evidence of lumbar and upper cervical subluxations. Subsequent X-rays revealed a double rotatory lumbar scoliosis and an axis odontoid fracture at its base. A cervical flexion X-ray revealed instability and a later computed tomography confirmed the fracture.Intervention and outcome:Due to poor patient compliance, a neurosurgical consultation and subsequent upper cervical arthrodesis did not take place until over 4 months after the initial diagnosis. A Brooks C1-C2 posterior fusion using Songer cables and an iliac crest bone graft resulted in a successful outcome. Prior to surgery, the patient's low back pain was managed by the chiropractor with a successful outcome.Conclusion:This case presents a rare, yet precarious situation with the chiropractic management of a patient with a potentially catastrophic condition. This clinical example also stresses the importance of careful clinical assessment and imaging procedures for patients before providing spinal adjustments in order to avoid a potential iatrogenic incident. This case report also demonstrates the successful outcome of specific chiropractic care in the amelioration of acute low back pain. |
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