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  This 20-year-old woman was admitted via the emergency room with severe radiating pain of the right upper extremity and moderate neck pain. Five days prior to admission, she had slipped on a slope. At that time, she was traveling in another country. At first, her radiating pain was not so severe; she was told that it was a simple strain, and was given some medication at an emergency room. As time went by, however, the radiating pain became aggravated, and she could not endure it. She returned to this country, and visited an emergency room as soon as she arrived.

  On physical examination, neurologic signs of C7 radiculopathy including sensory changes and weakness (grade 4) of the elbow extensor were noted, and even Spurling’s sign, shoulder abduction pain relief sign, and axial compression and distraction tests were positive, simulating cervical disc herniation. On lateral roentgenogram, the C6-7 disc space was narrowed. Careful review of flexion-extension lateral roentgenograms revealed a fracture of the superior articular process of C7, which was also found on the anteroposterior view. On oblique view, there was a minimal subluxation and narrowing the inferior portion of the intervertebral foramen where the cervical root is located. CT scan revealed displacement of the fracture fragment into the intervertebral foramen. The same finding was observed on magnetic resonance imaging, but soft disc herniation was not observed.







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    What is your choice of treatment?

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