{"doi":"10.1002/emp2.13222","title":"Adolescent male with neck pain","abstract":"A 12-year-old boy presented to the emergency department (ED) via emergency medical services following a football tackle injury associated with mild cervical neck pain and resolved left arm paralysis and paresthesia. He denied any headache, altered vision, confusion, nausea, vomiting, shooting pains, or weakness. He had no significant medical or surgical history with otherwise negative review of systems. On examination, he had age-appropriate vital signs, Glasgow Coma Score (GCS) of 15, and a cervical collar in place. He had cervical pain on palpation but without apparent deformities or step-offs. He had no neurological or motor deficits. Neck x-rays demonstrated a possible fracture at the left C5‒C6 facet joint versus an artifact from the cervical collar (Figure 1). A cervical computed tomography (CT) scan was recommended for clarification. Non-contrast CT of the C-spine showed dystopic os odontoideum slightly anterior to a dysplastic dens (Figure 2). Neurosurgery recommended flexion/extension x-rays (Figure 3), which revealed atlantoaxial instability (AAI). The patient was diagnosed with dystopic os odontoideum with marked AAI and underwent posterior C1‒C2 spinal fusion without any surgical complications. Sports-related trauma is a common reason for ED visits, although neck injuries are rare.1, 2 AAI, associated with os odontoideum, is a rare condition.3, 4 Os odontoideum occurs when the upper pole of the odontoid process is not fused with the body of the axis, and once thought to be a developmental defect, many cases are now believed to be trauma induced.3-7 Os odontoideum can cause life-threatening AAI and should be considered in athletes presenting with neck pain, stiffness, shoulder pain, torticollis, and occipital headaches.3, 7 Emergency practitioners frequently encounter sports-related traumatic injuries and must thoroughly evaluate red-flag symptoms. All neurologic symptoms, including transient symptoms, require further evaluation in the post-traumatic setting. Natalie J. Tedford's institution has received grant funding from the American Academy of Pediatrics Community Access to Child Health Program for investigator-initiated research and from the National Institute of Nursing Research of the National Institutes of Health for investigator-collaborative research. Cannon Nelson and Tala Mujahed declare they have no conflicts of interest. Natalie J. Tedford's institution has received grant funding from the American Academy of Pediatrics Community Access to Child Health Program for investigator-initiated research and from the National Institute of Nursing Research of the National Institutes of Health for investigator-collaborative research. There is no grant funding for this case report submission.","journal":"Journal of the American College of Emergency Physicians Open","year":2024,"id":498530,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":0,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9515,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2024-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1345226,"name":"Tala Mujahed","orcid":"0000-0002-0629-7648","position":1,"is_corresponding":false},{"id":873588,"name":"Natalie J. Tedford","orcid":"0000-0002-0753-1782","position":2,"is_corresponding":false},{"id":1345520,"name":"Cannon Nelson","orcid":null,"position":0,"is_corresponding":true}],"reference_count":6,"raw_metadata":null,"created_at":"2026-07-19T02:09:42.181447Z","pmid":"38887227","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}