Post-traumatic upper cervical subluxation visualized by MRI: a case report

Abstract

Background: This paper describes MRI findings of upper cervical subluxation due to alar ligament disruption following a vehicular collision. Incidental findings included the presence of a myodural bridge and a spinal cord syrinx. Chiropractic management of the patient is discussed.

Case presentation: A 21-year old female presented with complaints of acute, debilitating upper neck pain with unremitting sub-occipital headache and dizziness following a vehicular collision. Initial emergency department and neurologic investigations included x-ray and CT evaluation of the head and neck. Due to persistent pain, the patient sought chiropractic care. MRI of the upper cervical spine revealed previously unrecognized clinical entities.

Conclusion: This case highlights the identification of upper cervical ligamentous injury that produced vertebral subluxation following a traumatic incident. MRI evaluation provided visualization of previously undetected injury. The patient experienced improvement through chiropractic care.

Figure 1

T2 Weighted Image: Syrinx extending from C2-C7 (Large White Arrow).

Figure 2

Axial T2 Weighted Image reveals hyperintense signal corresponding to Alar Ligament sprain disruption (White Arrow).

Figure 3

Axial T2 Weighted Image – Translational atlanto-axial subluxation.

Figure 4

Sagital T2 Weighted Image – Myodural Connection (Black Arrow). Rectus Capitus Posterior Minor (White Arrow).

Figure 5

Axial 3D MRI – Rectus Capitus Posterior Minor (Arrow).

Figure 6

8-Way Neck Isotonic Exercise Rehabilitation.