Disclosures: Maria A. Vanushkina, MD: Nothing to disclose

Case Description: She reported occasional headaches and sharp neck pain provoked by movement accompanied by 5-10 minutes of whole-body cold sensation. Prior history included a trauma in which she struck her left posterolateral head at age 11 while standing up abruptly. At the time, she experienced acute onset paresis and dyspnea lasting several minutes and whole-body paresthesias lasting 90 minutes. Emergent head CT showed a scalp hematoma. At age 14, she reported a second head trauma, eliciting similar sensory symptoms 10-15 minutes duration. Upon presentation to our clinic, physical exam was normal, except for scapular dyskinesis, a positive right Hoffman’s sign, and 2 beats of clonus at bilateral ankles.

Setting: Outpatient Clinic

Patient: 20-year-old female presenting with headaches and neck pain.

Assessment/Results: Cervical MRI demonstrated an unfused fragment at the tip of the dens, moderate central canal narrowing posterior to C2 body, and increased T2 spinal cord signal at C2. Re-evaluation of the MRI characterized the fragment as a remote type II dens fracture with superior-anterior displacement of 6 mm. She was referred to neurosurgery and underwent a posterior spinal fusion. On follow-up, she developed mild spasticity of her quads and hamstrings.

Discussion: Although rare overall, Type II Dens fractures are the most common and can be potentially unstable, especially if displaced over 6 mm. The fracture may be easily missed in asymptomatic patients as neurological deficits are uncommon. We present a rare case of cervical myelopathy secondary to a displaced type-II dens fracture with nonunion following a low energy mechanism 9 years prior. In the pediatric population, cervical spine injuries are frequently incorrectly diagnosed or the diagnosis is delayed increasing the risk for neurological deficits.

Conclusion: This case demonstrates the importance of a thorough, organized method for examining the cervical spine in picking up rare and potentially dangerous etiologies of neck pain.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/cervical-myelopathy-secondary-to-delayed-diagnosis-of-remote-dens-fracture-in-a-college-student-a-case-report/