title: Osteoporotic fracture of the dens revealed by cervical manipulation.
abstract: Osteoporotic vertebral fractures selectively affect the thoracolumbar junction, usually sparing the cervical spine. A 65-year-old woman with documented osteoporotic fractures and chronic alcohol abuse presented with neck pain and occipital neuralgia that started after she suddenly flexed then extended her neck. Following several sessions of cervical manipulation, her pain became more severe, and she was admitted. Imaging studies showed multiple fractures in the dens, C6 and C7. These apparently spontaneous fractures suggested a bone tumor, for which investigations were negative. Osteoporosis was the only identifiable cause. The spinal manipulations probably worsened the lesions which were performed by a chiropractor who is not a physician and did not obtain cervical spine radiographs before treating the patient. Osteoporosis contraindicates spinal manipulation at any level, including the cervical spine.
authors.affiliation: Rheumatology Federation (Viggo Petersen Center), Lariboisière Teaching Hospital (Assistance Publique-Hôpitaux de Paris), 2, rue Ambroise-Paré, 75475 Paris cedex 10, France.
authors.forename: Hang-Korng
authors.initials: HK
authors.lastname: Ea
authors.forename: Anne-Joëlle
authors.initials: AJ
authors.lastname: Weber
authors.forename: François
authors.initials: F
authors.lastname: Yon
authors.forename: Frédéric
authors.initials: F
authors.lastname: Lioté
mesh_terms: D000368:Aged; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging; D000075202:Contraindications; D005260:Female; D006801:Humans; D020393:Manipulation, Spinal / Q000009:adverse effects*; D019547:Neck Pain / Q000628:therapy*; D009809:Odontoid Process / Q000293:injuries* / Q000473:pathology; D010024:Osteoporosis / Q000150:complications*; D011859:Radiography; D011877:Radionuclide Imaging; D016103:Spinal Fractures / Q000175:diagnosis* / Q000209:etiology*