Odontoid fracture after fall and following manipulation of the cervical spine – a case report -

Introduction: Manipulation and mobilisation of the spine are forms of manual therapy that are often used to treat patients with neck pain and muscle-tension headache. In the absence of representative studies the incidence of serious adverse events is unknown and can only be estimated. Current retrospective studies indicate ranges from 1 in 50,000 to 1 in 5 million manipulations.

Case: We report on a 5 5/12 year old girl who suffered an odontoid fracture after manipulation of the cervical spine after a fall from a ladder of her loft bed (height approximately 90cm). After the trauma the girl showed no neurological deficits and was always full conscious. The X-ray taken on the first day showed no pathology. Two days after the accident the girl suffered from neck pain and headache. Therefore she was seen by an orthopedics and cervical manipulation was performed. After that the pain improved for a short time. One week later the girl suffered from severe pain. On the following images of the cervical spine a fracture of the odontoid was evident (type II-III according to Anderson and d'Alonzo). Operative therapy was performed. The girl never showed any neurological deficits and was discharged in healthy condition.

Discussion: The most frequently reported serious complications of cervical spine manipulations are arterial dissections. To our knowledge odontoid fractures have never been reported. In our case it is difficult to decide whether there was an injury of the dens right after the trauma not detectable in the X-ray or if the manipulation itself caused the fracture and dislocation. This case as well as a review of the literature demonstrate the need of prospective studies concerning the risks of manipulation therapy. Furthermore manipulations of the cervical spine are highly questionable.