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A pain in the neck

¹ St James's University Hospital NHS Trust, Leeds, Middlesbrough, UK ² Middlesbrough General Hospital, Middlesbrough, UK

This excerpt was created in the absence of an abstract.

A previously healthy 24-year-old man injured his neck in a rugby match and complained of neck pain. There was no history of previous neck trauma. On examination his neck was diffusely tender and there was generalized reduction in neck movements. Plain radiographs of the cervical spine were obtained (Figures la, b). What do they show and what is the diagnosis? How would you confirm this?

The antero-posterior (AP) radiograph of the upper cervical spine (Figure la) shows bilateral atlantoaxial offset of 4 mm. The initial diagnosis was of a burst fracture of the atlas (Jefferson fracture) and a computed tomography (CT) scan was performed to confirm this (Figure 2). CT demonstrated a well-defined, smooth, corticated anterior cleft and a midline posterior defect. No fracture was seen. A diagnosis of bipartite atlas was made. Following CT the plain radiographs were reviewed and several abnormalities observed which had not been previously appreciated. On the lateral radiograph (Figure lb) there was absence of the cortical outline to the anterior tubercle of the atlas and similarly there was no arch–canal line posteriorly.

Received for publication October 1, 1991. Accepted for publication October 30, 1991.