Case Series and Surgical Management of Cervical Spine Pathology Mimicking as Traumatic Fractures

Introduction: Cervical spine fractures are becoming an increasing concern for orthopedic and neurosurgeons given the unique anatomy and role of the cervical spine in maintaining the spinal nerves essential to extremity sensation and movement and providing an extensive range of motion to the head and neck. Each year, cervical spine injuries cause an estimated 6000 deaths and 5000 new cases of quadriplegia. Though they may be of lower prevalence compared to that of traumatic fractures, the risk that pathological fractures to the cervical spine (PFCS) pose to patients’ life, health, and socioeconomic wellbeing make diagnosis and treatment of PFCS of key importance. We present six cases of patients who sustained PFCS.

Methods: Patient data was collected retrospectively between the years of 2020-2023 from the case logs of three separate neurological surgeons at our tertiary care center at St. Elizabeth’s Medical Center. The search was narrowed to identify patients with initial presumed traumatic fractures of the cervical spine that were discovered to have a PFCS intra- or postoperatively. Meditech and Athena were used to collect the relevant histories, CT/MRI scans, and surgical management for each patient that had a PFCS.

Results: The authors found six cases of pathological fractures that were initially presumed to be traumatic within their institution. The etiologies of the PFCS from these cases were TB, plasmacytoma, multiple myeloma, and osteomyelitis from IVDU and Hepatitis B. All of the cases, save for the second and fourth, were associated with infectious etiologies. Of particular interest is case three, who was discovered to have a rare form of vertebral non-caseating granulomatous disease due to Q fever.

Conclusion : Pathological fractures of the cervical spine, as observed in the six cases presented by the authors, can easily masquerade as traumatic fractures upon inspection of radiographic imaging alone and thus must be combined with a thorough history, physical examination, and pathology reports in order to properly distinguish such fractures from traumatic fractures. Further studies will likely reveal additional etiologies not demonstrated in this study.