The Invisible Fatal Injury: Postmortem Revelation of Cervical Spine Fracture/Dislocation: A Case Report

Author's Information:

Ogbata SE

Department of Anatomic Pathology, Federal Medical Centre Umuahia, Abia State, Nigeria/Department of Anatomic Pathology, Faculty of Basic Clinical Sciences, College of Medicine and Health Sciences, Gregory University Uturu, Abia State, Nigeria 

Ehidiamhen FE

Department of Anatomic Pathology, David Umahi Federal University Teaching Hospital, Uburu, Ebonyi State, Nigeria 

Chukwuegbo CC 

Department of Anatomic Pathology, Federal Medical Centre Umuahia, Abia State, Nigeria/Department of Anatomic Pathology, Faculty of Basic Clinical Sciences, College of Medicine and Health Sciences, Gregory University Uturu, Abia State, Nigeria 

Ogbata LNN

 Nursing Services Department, Federal Medical Centre Umuahia, Abia State 

Jegede OO

Department of Anatomic Pathology, Federal Medical Centre Umuahia, Abia State, Nigeria/Department of Anatomic Pathology, Faculty of Basic Clinical Sciences, College of Medicine and Health Sciences, Gregory University Uturu, Abia State, Nigeria 

Nnoli MA

Department of Pathology, University of Calabar Teaching Hospital, Cross River State, Nigeria.

Vol 02 No 08 (2025):Volume 02 Issue 08 August 2025

Page No.: 70-72

Abstract:

Cervical spine injuries can be rapidly fatal, often without overt external signs, particularly in high-energy trauma such as road traffic accidents (RTAs). We report the case of a middle-aged man who died shortly after a night time RTA. Although he sustained only minor cutaneous injuries, autopsy revealed a fatal C6–C7 cervical spine fracture-dislocation associated with massive internal haemorrhage. This case underscores the importance of maintaining a high index of suspicion for spinal injuries in trauma cases and highlights the critical role of postmortem examination in uncovering hidden fatal injuries. 

KeyWords:

Cervical spine fracture, Road traffic accident, Internal haemorrhage, Autopsy, Spinal trauma, Sudden death

References:

  1. Benzel. E. C., Hart, B. L., Ball, P. A., Baldwin, N. G., Orrison, W. W., & Espinosa, M. C. (1996). Magnetic resonance imaging for the evaluation of patients with occult cervical spine injury. Journal of Neurosurgery, 85(5), 824-829.
  2. DiPompeo, C. M., & Das, J. M. (2023). Subaxial cervical spine fractures. In StatPearls. StatPearls Publishing. Retrieved June 13, 2025, from https://www.ncbi.nlm.nih.gov/books/NBK546617/
  3. Fehlings, M. G., Vaccaro, A., Wilson, J. R., Singh, A., Cadotte, D. W., Harrop, J. S., et al. (2012). Early versus delayed decompression for traumatic cervical spinal cord injury: results of the Surgical Timing in Acute Spinal Cord Injury Study (STASCIS). PloS ONE, 7(2), e32037.
  4. Hoffman, J. R., Mower, W. R., Wolfson, A.B., Todd. K. H., & Zucker, M. I.; National Emergency X-Radiography Utilization Study Group. (2000). Validity of a set of clinical criteria to rule out injury to the cervical spine in patients with blunt trauma. New England Journal of Medicine, 343(2), 94-99. 
  5. IATSS Research. (2014). Fatal traffic accidents and forensic medicine. IATSS Research, 38(1), 71-76.
  6. Leucht, P., Fischer, K., Muhr, G., and Stübig, T. (2009). Epidemiology of traumatic spine fractures. Injury, 40(2), 166–172. 
  7. Lin, J.T., Lee, J.L., & Lee, S.T. (2003). Evaluation of occult cervical spine fractures on radiographs and CT.Emergency Radiology, 10(2), 128-134.
  8. Peck, R.C., Gebers, M. a., Voas, R. B., and Romano, E. (2008). The relationship between blood alcohol concentration (BAC), age, and crash risk. Journal of Safety Research, 39(3), 311-319.
  9. Radiology Assistant. (2008). Cervical injuries: Neurology overview. Retrieved June 10, 2025, from https://radiologyassistant.nl
  10. Sacco, M.A., Verrina, M.C., Raffaele, R., Gratteri, S., Tarallo, A.P., et al. (2025).The role of autopsy in forensic and clinical evaluation of head and spinal trauma in road traffic accidents: A review of the literature. Diagnostics, 15(4), Article 442.
  11. Stiell, I. G., Clement, C. M., McKnight, R. D., Brison, R., Schull, M., Rowe, B.H., et al. (2003). The Canadian C-spine rule versus the NEXUS low-risk criteria in patients with trauma. New England Journal of Medicine, 349(26), 2510–2518.
  12. Wang, T. Y., Mehta, V. A., Dalton, T., Sankey, E. W., Goodwin, C. R., Karikari, I. O., et al. (2021). Biomechanics, evaluation, and management of subaxial cervical spine injuries: A comprehensive review of the literature. Journal of Neuroscience, 83, 131-139.
  13. World Health Organization. (2018). Global status report on road safety 2018.
  14. World Federation of Societies of Anaesthesiologists. (2013). The unstable cervical spine (Anaesthesia Tutorial of the Week, No. 292). Retrieved June 10, 2025, from Resources. WFSAhq.org