A Rare Case of Cervicalgia

Abstract

Objective To underline the importance of a detailed diagnosis of pain and perform self-criticism regarding the delay in diagnosis of a case of mechanical cervicalgia.

Material and methods We present the case of a patient with sudden neck pain, with normal X-rays. The magnetic resonance imaging (MRI) scan was apparently unremarkable, and the condition was treated as mechanical cervicalgia. After several consultations in the Emergency Department, a new X-ray was performed, which showed an anomaly between the first vertebrae and is accompanied by a computed tomography (CT) scan that revealed a fracture of the odontoid apophysis and destruction of the second cervical vertebra of metastatic origin.

Results The patient was treated with radiotherapy plus cervical collar and several cycles of chemotherapy, and died two years later.

Discussion The cancers that most frequently metastasize to the spine are those of the breast, lung and prostate, with the most frequent location being thoracic (70%), lumbar (20%), and, finally, cervical (10%). When the tumor is discovered as a metastasis, as in our case, these patients have a high mortality rate. To our knowledge, few cases of neoplasms discovered as pathological fractures of the odontoid apophysis have been described in the literature.

Conclusion Non-mechanical cervicalgia due to metastasis of the odontoid apophysis as a result of an undiagnosed lung neoplasm is a rare case in the literature and a complex diagnosis, in which a detailed clinical history of the evolution of pain and the presence of red flags are of vital importance for its suspicion and rapid diagnosis, through techniques such as MRI.

Keywords

cervicalgia - metastasis - odontoid apophysis - delay in diagnosis

Publikationsverlauf

Eingereicht: 12. Januar 2020

Angenommen: 18. Mai 2022

Artikel online veröffentlicht:
03. Oktober 2022

• Referencias

• 1 Lakemeier S, Westhoff CC, Fuchs-Winkelmann S, Schofer MD. Odontoid process metastasis of bronchial carcinoma as a rare cause for nonmechanical neck pain: a case report. Cases J 2009; 2: 8173
• 2 Aydinli U, Ozturk C, Bayram S, Sarihan S, Evrensel T, Yilmaz HS. Evaluation of lung cancer metastases to the spine. Acta Orthop Belg 2006; 72 (05) 592-597
• 3 Harrington KD. Metastatic disease of the spine. J Bone Joint Surg Am 1986; 68 (07) 1110-1115
• 4 Stark RJ, Henson RA, Evans SJ. Spinal metastases. A retrospective survey from a general hospital. Brain 1982; 105 (Pt 1): 189-213
• 5 Bartanusz V, Porchet F. Current strategies in the management of spinal metastatic disease. Swiss Surg 2003; 9 (02) 55-62
• 6 Rayan F, Mukundan C, Shukla DD, Barrington RL. Odontoid metastasis: a potential lethal complication. J Orthop Traumatol 2009; 10 (04) 199-201
• 7 Lally JF, Cossrow JI, Dalinka MK. Odontoid fractures in metastatic breast carcinoma. AJR Am J Roentgenol 1977; 128 (05) 817-820
• 8 Calvo Gutiérrez J, Collantes Estévez E. Protocolo diagnóstico de la cervicalgia inflamatoria. Medicine (Baltimore) 2013; 11 (31) 1949-1953
• 9 Gimenez Serrano S. Cervicalgias. Tratamiento integral. Farmacia profesional Vol 18 Núm 2 Febrero 2004
• 10 Lopez Cuenca S. et al. Guía clínica de cervicalgia y dorsalgia. Fisterra. 2016
• 11 Fernández Castro M. Protocolo diagnóstico de la cervicalgia. Medicine (Baltimore) 2009; 10 (30) 2038-2041
• 12 Cheng JS, McGirt MJ, Degin C. Neck pain. En: Firestein GS, Budd RC, Gabriel SE, McInnes IB, O'Dell JR. editors. Kelly's Textbook of Rheumotology. 9th ed.. Philadelphia, PA: Elsevier Saunders; 2012
• 13 Côté P, van der Velde G, Cassidy JD. et al; Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders. The burden and determinants of neck pain in workers: results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders. Spine 2008; 33 (4, Suppl): S60-S74
• 14 Haldeman S, Carroll L, Cassidy JD, Schubert J, Nygren A. Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders. The Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders: executive summary. Spine 2008; 33 (4, Suppl): S5-S7
• 15 Rao R. Neck pain, cervical radiculopathy and cervical myelopathy. The Journal of Bone & Joint Surgery. JBJS.ORG. Volume 84-A · Number 10 · October 2002
• 16 Shaw B, Kinsella R, Henschke N, Walby A, Cowan S. Back pain “red flags”: which are most predictive of serious pathology in the Emergency Department?. Eur Spine J 2020; 29 (08) 1870-1878
• 17 Childress MA, Stuek SJ. Neck pain: initial evaluation and management. Am Fam Physician 2020; 102 (03) 150-156