Os Odontoideum: the need for vigilance in our screening examinations

Posted by NAIOMT on Oct 5, 2016 7:08:00 PM

By Brett Windsor, PT


In the world of manual therapy and in particular at NAIOMT, we are constantly reminded of the need to be vigilant in our screening examinations. Much of the serious pathology that can potentially compromise the stability or vascular integrity of the cervical spine presents in the manner as would any relatively simple mechanical neck pain. I was recently reminded of this point while reading a case study in a recent issue of the Journal of the Canadian Chiropractic Association. It describes the case of a 54 year old male presenting to a chiropractor with chronic neck pain absent headache. The patient had a history of previous trauma and episodes of pain for which he had received treatment. The DC ordered up copies of previous MRI's and radiographs. In the meantime, following examination, the patient was treated with mobilization and manipulation. No adverse effects were noted either at the time of treatment or upon the patients return a few days later.

Here's the interesting part...when the reports showed up a few days later, having been done a few years prior, they showed the presence of an 'Os Odontoideum', or as specifically described in this case, a remote fracture of the dens at the base of C2. Flexion-Extension radiographs showed a decrease in the A-P width of the spinal canal at the C1-2 segment, so it is fair to say that the condition was compromising the stability of the upper cervical segments. I bet there were a few nervous moments upon reading that!!. Happy days were here again when the patient showed up showing no ill-effects from the previous manipulation. It is difficult to fault the Dc in this case - a neurological examination was clear and there were no obvious signs that there was a problem.

But...could a case have be made that this patient should never have never been manipulated? Perhaps...

Topics: differential diagnosis, joint manipulation, PT, Clinical Reasoning

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