Korean J Pain.  2012 Oct;25(4):258-261. 10.3344/kjp.2012.25.4.258.

Unrecognized C1 Lateral Mass Fracture Without Instability; The Origin of Posterior Neck Pain

• Seo SJ
• Kim HR
• Choi EJ
• Nahm FS

• KMID: 2278167
• DOI: http://doi.org/10.3344/kjp.2012.25.4.258

Abstract

Posterior neck pain is a common complaint of patients in the pain clinic. The atlas (C1) burst fracture is known to be a cause of posterior neck pain and instability. Although the atlas burst fracture and instability can be discovered by plain X-rays which show lateral mass displacement or widening of the atlantodental interval, assessment of an atlas burst fracture can be difficult if there is no instability in the imaging study. Here we report a case of a 46-year-old female patient who had complained of sustained posterior neck pain for 6 months. Plain X-rays showed only disc space narrowing at C4/5 and C5/6, without any cervical instability. However, an unrecognized C1 lateral mass fracture was detected by CT and MRI. The patient's pain was then successfully treated after atlantoaxial joint injection with a C2 DRG block.

Keyword

cervical atlas; injuries; neck pain; spinal fractures

MeSH Terms

Atlanto-Axial Joint
Cervical Atlas
Diagnosis-Related Groups
Displacement (Psychology)
Female
Humans
Middle Aged
Neck Pain
Pain Clinics
Spinal Fractures

Figure

• 

  Fig. 1 Lateral flexion (A)-extension (B) views on plain X-ray. There is no atlantoaxial instability.

• 

  Fig. 2 Axial view on cervical CT scan shows an old fracture of the lateral mass at C1 and a suspicious avulsion injury of the right transverse ligament.

• 

  Fig. 3 T1-weighted MR parasagittal images of the right (A) and left (B) cervical facets and C2 nerve root. The right C2 nerve root is compressed by C1/2 facet subluxation.

Reference

1. Kakarla UK, Chang SW, Theodore N, Sonntag VK. Atlas fractures. Neurosurgery. 2010; 66:60–67. PMID: 20173529.

2. Dickman CA, Mamourian A, Sonntag VK, Drayer BP. Magnetic resonance imaging of the transverse atlantal ligament for the evaluation of atlantoaxial instability. J Neurosurg. 1991; 75:221–227. PMID: 2072158.

3. Spence KF Jr, Decker S, Sell KW. Bursting atlantal fracture associated with rupture of the transverse ligament. J Bone Joint Surg Am. 1970; 52:543–549. PMID: 5425648.

4. Sherk HH, Nicholson JT. Fractures of the atlas. J Bone Joint Surg Am. 1970; 52:1017–1024. PMID: 5479472.

5. Landells CD, Van Peteghem PK. Fractures of the atlas: classification, treatment and morbidity. Spine (Phila Pa 1976). 1988; 13:450–452. PMID: 3187689.

6. Fielding JW, Cochran GB, Lawsing JF 3rd, Hohl M. Tears of the transverse ligament of the atlas. A clinical and biomechanical study. J Bone Joint Surg Am. 1974; 56:1683–1691. PMID: 4434037.

7. Dickman CA, Greene KA, Sonntag VK. Injuries involving the transverse atlantal ligament: classification and treatment guidelines based upon experience with 39 injuries. Neurosurgery. 1996; 38:44–50. PMID: 8747950.

8. Kesterson L, Benzel E, Orrison W, Coleman J. Evaluation and treatment of atlas burst fractures (Jefferson fractures). J Neurosurg. 1991; 75:213–220. PMID: 2072157.