Instructive Case Review

C1 Lateral Mass Fracture

Contributed by: James Demetrious, DC, DABCO

A 77-year old woman fell backwards striking the back of her head on a concrete floor. She sought the care of her primary care physician (PCP). An attending radiologist reported DJD with no acute abnormalities. Patient presented for chiropractic care due to worsening sub-occipital pain. Acute pain is elicited upon palpation of the C2 spinous process. Chiropractic review of the medical x-rays revealed a compression fracture of the right C1 lateral mass. The patient was referred back to the PCP for CT evaluation of the upper cervical spine. The PCP ordered an MRI that revealed increased signal intensity of the C1 lateral mass and C2 vertebra consistent with compression fracture. A neurosurgeon recommended observation without surgical intervention.

This case illustrates the vital role advanced chiropractic physicians play in the care of patients. Inherent to medical practice, there is a foundational principal of redundancy that protects patients. While a medical PCP may not have the insight or training to directly evaluate nuanced spinal or musculoskeletal conditions, the chiropractic physician is well trained and helpful in this regard. This is particularly important when other specialists miss vital diagnostic assessments. The chiropractic physician can ensure and participate as a primary conduit of assessment and care for nuanced neuromusculoskeletal conditions.

For a more detailed description of this patient presentation, go to the NCMIC Examiner publication.