title: Pathological cervical fracture after spinal manipulation in a pregnant patient.
abstract: OBJECTIVE
  To present the rare case of a displaced odontoid fracture after manipulative treatment.
  
  
  METHODS
  A 37-year-old, 15-week pregnant patient was referred with acute neck pain and a diffuse paravertebral swelling that started after cervical manipulation performed by her general medical practitioner 5 days before. Because of pregnancy, a cervical spine radiographic series was not obtained before treatment. Magnetic resonance imaging revealed a displaced odontoid fracture associated with a pathological process in the vertebral body of C2 and a paravertebral hematoma on the left side from C2 to C4.
  
  
  RESULTS
  After initial halo vest immobilization, an anterior-posterior fusion of C1-C2 was performed. The histological analysis showed features of an aneurysmal bone cyst. The patient was discharged and had an undisturbed pregnancy and was without any neurological complications.
  
  
  CONCLUSIONS
  Because of the weakening lesion in C2, the spinal manipulation most likely caused the displaced odontoid fracture. Special imaging should be performed, preferably with magnetic resonance imaging, when a patient experiences significant new symptoms after cervical manipulation.
authors.affiliation: Department of Orthopaedic Surgery, University of Bonn, Germany. a.schmitz@uni-bonn.de
authors.forename: Alfred
authors.initials: A
authors.lastname: Schmitz
authors.forename: Goetz
authors.initials: G
authors.lastname: Lutterbey
authors.forename: Lars
authors.initials: L
authors.lastname: von Engelhardt
authors.forename: Marcus
authors.initials: M
authors.lastname: von Falkenhausen
authors.forename: Michael
authors.initials: M
authors.lastname: Stoffel
mesh_terms: D000328:Adult; D002574:Cervical Vertebrae / Q000293:injuries*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D026882:Manipulation, Chiropractic / Q000009:adverse effects*; D009809:Odontoid Process / Q000293:injuries*; D011247:Pregnancy; D016103:Spinal Fractures / Q000209:etiology*