Overcrowding in emergency department: an international issue

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Initially overseen vertebral body luxation: diagnosed by dynamic fluoroscopy due to delayed dysphagia

This study relates to the case report of a neurologically intact 13-year-old boy with unrecognized traumatic bipedicular vertebral fracture. He was diagnosed complete vertebral body luxation 1 day later by dynamic fluoroscopy, then successfully treated with surgery that resulted in total recovery. The delayed diagnosis highlights the importance of detailed initial clinical and radiology examinations, even when overt symptoms as diagnostic indicators of severe neurological sequelae expected in similar traumatic vertebral fractures are lacking. A 13-year-old boy, who met with a minor bicycle accident, was presented with two small forehead lacerations but without pain or clinical neurological symptoms for radiological examination, which showed no abnormalities. The following day, however, the patient complained about dysphagia and underwent dynamic fluoroscopy for the assessment of deglutition that revealed a total block of contrast medium. Computer tomography (CT) of the cervicothoracic junction showed a bipedicular thoracic vertebral fracture and a hooked vertebral body luxation causing mechanical dysphagia but, surprisingly, without compression of the spinal cord. The patient fully recovered after carefully carried out protracted distension and orthopaedic surgery with vertebral fusion.. One year after surgery, the patient had clinically resumed normal function, and CT showed a sufficient vertebral bony consolidation with anatomical alignment. This case exemplifies the importance of careful initial clinical examination and spinal CT after accidents encompassing an increased risk of spinal fractures, even if neurologically unapparent