Unrecognized Spinal Instability Associated with Seemingly “Simple” Cervical Compression Fractures

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Abstract
Patients (27) who had seemingly stable compression cervical vertebral fractures were described. All were treated in cervicothoracic orthoses. None were initially treated in a Halo device or with surgery. Twenty patients were stable and healed without progressive displacement, angulation, or pain. One patient demonstrated an angular deformity, which spontaneously stabilized within 6 mo. with anterior bony ankylosis in a kyphotic position. Six patients demonstrated persistant progressive post-injury instability related to posterior ligament rupture. As muscle spasm diminished, the patients could be given a more reliable flexion-extension radiographic examination, unmasking the hidden posterior instability. Five of the 6 who demonstrated this instability were disabled because of pain. Two of the six patients were treated with a 2-segment fusion. The other 4 have had fusion recommended and are currently being followed clinically. The need for better initial criteria of potential instability and close follow-up of patients with simple compression fractures of the cervical spine is emphasized.

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