Balancing Act: The Challenge to Diagnose Neck Instability

Lucinda Kurzava Kendall DO, David Jevotovsky MD MBA, Haruki Ishii MD, Salvador Portugal DO MBA

Atlanto-occipital dissociation injuries are rare but often fatal traumatic injuries to the cranio-cervical junction. Early diagnosis and surgical stabilization are required due to the risk for secondary brainstem injury. We present the case of a patient evaluated in our outpatient physiatry clinic for neck pain after a full ED work-up for cervical spine injury was unrevealing for acute anatomic abnormality. Patient history with subtle physical exam findings were the sole indication that additional emergent MRI imaging was warranted despite previously benign X-rays and CT scans.