Emergency Medicine: Open Access
Open Access

Abstract

A Missed Diagnosis of Cervical Spine Fracture in Alcohol Intoxicated Patient

Ramesh Muthu and Surekha Kaneson

Introduction: A significant cervico-thoracic spondylolisthesis with bilateral facet joint dislocation is very unstable and can lead to devastating consequences if not diagnosed early. Symptomatic spondylolisthesis is frequently missed at Emergency Department (ED) due to various reasons. Besides inadequate radiographs, lack of cooperation by patients who are under alcohol intoxication is also one of the causative factors resulting in missed diagnosis of cervical spine fracture during the clinical assessment.
Case Presentation: Forty three year old man, a chronic alcoholic presented to our emergency department with a missed diagnosis of C7-T1 anterolisthesis with bilateral facet joint dislocation. He had a fall from a height and sustained neck pain. Patient had multiple visits to our ED for the same complaint and was noted intoxicated with alcohol during both his visits. The radiograph images of the cervical spine did not include the vertebral spine below C6 in lateral view. It was interpreted as negative for fracture or dislocation, therefore the patient was discharged with analgesics. Subsequently, the patient developed bilateral lower limb weakness and loss of function of his fingers.
Conclusion: An accurate and detailed history, physical examination and diagnostic imaging are essential for the diagnosis of cervical spine injury in alcohol intoxicated patients. These are not to be missed in order to avoid medico legal issues in the future. This case will not be missed if the fundamental rules of assessing a cervical lateral x-ray are followed.