Medico-legal implications of C1 vertebral fractures

• Main Authors: Tatiana Iov, Diana Bulgaru-Iliescu, Simona Damian, A. Knieling, Mădălina Maria Diac, D. Tabian, Sofia David
• Format: Article
• Language: English
• Published: London Academic Publishing 2018-09-01
• Series: Romanian Neurosurgery
• Subjects: C1 fracture; diagnosis; injury mechanism
• Online Access: https://www.journals.lapub.co.uk/index.php/roneurosurgery/article/view/1109

Introduction: The upper C1-C2 column is the subject of several erroneous diagnostics. The most common mechanisms of injuries include fall from high-impact skulls, car accidents, etc. Vertebra C1 can also be injured by mild trauma. The Japanese show that atlas fractures occur in about 2-13% of the cervical spine fractures and about 1.3% of the total spinal cord injuries. It is underlined that CT examination is the most useful diagnostic method. The Czechs show that the atlas lesions appear in 1-2% of the cervical spine lesions. Americans reported fracture of the atlas in 7% of the cervical spine fractures. Even if CT has shown its value, lateral radiography is recommended in C1-C2 fractures. When victims are children or people injured in high-speed car crashes, the reported mechanisms were the fall from a high level and the impact on the tip of the flexed skull. The Italians mention that the C1-C2 area is the most exposed diagnostic area with errors. Material and methods: given the difficulty of establishing a diagnosis of C1 type fractures, we present in this paper such a case. We highlight the value of a CT scan. The victim is a 26-year-old woman with a trauma from the wall. The main issue in this case is that the diagnosis made by the radiologist seems to be wrong, the electronic and imprinted copies are of inferior quality. A second opinion revealed a very fine fracture that seemed to come from an older date than the date when the victim claimed she was assaulted. The better the lesions, the more misleading the interpretations. Any imaginary imaging lesion, especially if it is obvious in electronic reconstructions, must be brought to the attention of the physician if they are taken into account by "image". The axial CT sections may omit some lesions under certain conditions, for example at the upper and lower poles of a spherical, ovoid or cubic structure, such as the atlas lateral mass. Conclusions: the diagnostic solution in this case is the reconstruction of the axial sections in several planes. The crack can be highlighted, in the case of a reconstructed image, only after stacking the axial images. The mechanism could be through sudden compression, during a sudden head movement, uninitiated and uncontrolled by the neck muscles, when a movement occurs over the degree of elasticity of the occiput-atlas joint, the occipital condyles compressing abruptly, unilaterally one of the atlas masses. In such clinical cases, we experience pain, muscle contraction and torticollis, on a normal neurological background.