A Missed Subtle Sign on Cervical Computed Tomography Scan - A Case Report on Our Aching Experience
- Author:
TEH Kai HEAN
;
YONG Shao WEI
;
Jaya THILAK A/L SHANMUGAM
;
LIM Han SIM
;
GURMEET Singh A/L Sewa SINGH
;
ZAIRUL Anuar B Kamarul BAHRIN
- Publication Type:Case Report
- Keywords:
Cervical spine;
Cervical collar;
C-spine clearance;
Trauma;
Missed Injury I TEH Kai Hean1*;
YONG Shao Wei1;
Jaya THILAK a/l Shanmugam2;
LIM Han Sim2;
GURMEET Singh A/L Sewa Singh1;
ZAIRUL Anuar B Kamarul Bahrin2
- From:
Brunei International Medical Journal
2025;21():209-212
- CountryBrunei Darussalam
- Language:English
-
Abstract:
Stringent criteria have traditionally guided cervical clearance in trauma patients, particularly those who exhibit mid -line cervical pain or cannot undergo a reliable examination. This can sometimes result in extended periods of cervical immobilisation or necessitate the use of further imaging scans. In the absence of fractures, dislocation, or pathological subluxation on cervical computed tomography (CT) scan, cervical collar can be safely removed. We report a polytrauma case with altered consciousness, where bilateral facet fracture dislocation at the C5/C6 level was initially overlooked. CT scan of the spine revealed traumatic brain injury and lumbar vertebral fracture, and the collar was removed and proceeded with surgical stabilisation. The progress was complicated a pulmonary embolism and CT scan also identified the overlooked cervical injuries. A retrospective review of the initial scan revealed the presence of subtle signs of a small unilateral facet avulsion fragment. Our patient succumbed to his injuries. This discovery underscores the potential for pathologies to be missed with dire consequences. Our case illustrates the severe outcomes that can arise from overlooking a cervical spine injury, underscoring the importance of keeping cervical collars in place for high-risk patients until comprehensive imaging can be performed.
