Un caso raro de cervicalgia / A rare case of cervicalgia

OBJETIVO Subrayar la importancia del diagnóstico detallado del dolor y realizar autocrítica por la tardanza diagnóstica de una cervicalgia mecánica. MATERIAL Y MÉTODOS Se presenta una paciente con dolor súbito en el cuello, con radiografías y exploración normales. La resonancia magnética (RM) resultó aparentemente anodina y se trató como cervicalgia mecánica. Tras varias consultas con el Servicio de Urgencias, se realizó una radiografía que informó de anomalía entre las primeras vértebras y se amplió con una tomografía computarizada (TC) que reveló fractura de odontoides y destrucción de la segunda cervical de origen metastásico.RESULTADOS La paciente fue tratada con radioterapia más collarín cervical y varios ciclos de quimioterapia, y falleció a los dos años.DISCUSIÓN Los cánceres que más frecuentemente metastatizan en la columna vertebral son los de mama, pulmón y próstata, siendo las localizaciones más frecuentes la torácica (70%), la lumbar (20%) y, por último, la cervical (10%). Cuando el tumor se descubre como metástasis, como en nuestro caso, estos pacientes tienen una alta tasa de mortalidad. Según nuestro conocimiento, en la literatura hay pocos casos descritos de neoplasias descubiertas como fractura patológica de odontoides. CONCLUSIÓN El dolor cervical no mecánico debido a una metástasis en odontoides, a consecuencia de una neoplasia de pulmón no diagnosticada, es un caso raro en la literatura y de complejo diagnóstico, en que una historia clínica detallada de la evolución del dolor y la presencia de signos de alarma son de vital importancia para su sospecha y rápido diagnóstico, mediante técnicas como la RM.

OBJETIVE 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. MATERIALS 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.

Correlation between cervical curvature and cervical disc bulging in young patients with neck pain / 中国骨伤

OBJECTIVE@#To explore the correlation between the curvature of the cervical spine and the degree of cervical disc bulging in young patients with cervical pain.@*METHODS@#The clinical data of 539 young patients with neck pain from January 2015 to December 2018 were retrospectively analyzed. There were 251 males and 288 females, aged 18 to 40 (32.2±6.3) years old. The cervical curvature and cervical disc bulging were measured by cervical X-ray and MRI. According to cervical curvature, the patients were divided into 175 cases of cervical lordosis group (cervical curvature > 7 mm), 163 cases of cervical erection group (0