A case of vertebral metastasis with pathologic c2 fracture.
OBJECTIVE
This report discusses a patient with a pathologic fracture of the C2 vertebra secondary to osteolytic metastasis from squamous cell carcinoma of the lung.


METHODS
The patient was a 68-year-old man with a chief complaint of neck pain who was referred by his physician to a chiropractic office. The initial onset of neck pain began after a forceful sneeze that resulted in a sensation of "a twig snapping" in the neck. Radiographs revealed osteolytic destruction and pathologic fracture of the C2 spinous process.


RESULTS
The patient was referred back to his primary care physician, who then referred him to an oncologist, who immediately initiated a course of radiation therapy and pain medication. Palliative care by the chiropractor consisted of soft tissue massage of the cervical spine musculature to treat associated muscle spasms and pain. The patient responded well to gentle myofascial therapy. However, the osteolytic destruction of the C2 posterior elements progressed, resulting in an unstable subluxation of C2 and associated cord compression. The spine was stabilized with a rigid collar, but the metastatic destruction progressed, eventually resulting in quadriplegia and subsequent death from respiratory distress.


CONCLUSIONS
Patients with a history of cancer complaining of new onset of back or neck pain should be assumed to have vertebral metastasis until proven otherwise. Trivial trauma should be taken seriously in these cases and investigated with appropriate clinical, laboratory, and imaging examinations. Vertebral malignancies may be a contraindication to spinal manipulation; however, the chiropractic physician plays a significant role in early detection and diagnosis.
Davis
Matthew A
MA
Chiropractic Physician, Carlos G Otis Health Care Center Inc, Townshend, VT 05353, USA.
Taylor
John A M
JA
D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000150:complications* / Q000556:secondary* / Q000628:therapy; D002574:Cervical Vertebrae / Q000293:injuries*; D018450:Disease Progression; D017809:Fatal Outcome; D005598:Fractures, Spontaneous / Q000209:etiology*; D006801:Humans; D004204:Joint Dislocations / Q000209:etiology; D008175:Lung Neoplasms / Q000473:pathology*; D008297:Male; D019547:Neck Pain / Q000000981:diagnostic imaging / Q000209:etiology; D010015:Osteolysis, Essential / Q000000981:diagnostic imaging / Q000209:etiology; D013902:Radiography, Thoracic; D013117:Spinal Cord Compression / Q000209:etiology; D013122:Spinal Diseases / Q000000981:diagnostic imaging / Q000209:etiology; D013124:Spinal Injuries / Q000209:etiology; D013125:Spinal Neoplasms / Q000150:complications* / Q000556:secondary* / Q000628:therapy; D014057:Tomography, X-Ray Computed