Coroner's Finding: Horcicka, Josef Vratislav

89y · Male·fractured cervical spine (C5 inferior articular process fracture) due to unwitnessed mechanical fall at home

An 89-year-old man with Parkinson's disease fell at home on 16 August 2016, sustaining a cervical spine fracture. Initial CT imaging missed the C5 inferior articular process fracture, reporting only a paraspinal haematoma. Conservative management with mobilisation by an occupational therapist caused ligament disruption and spinal cord compression, converting the injury to a C5-C6 paraplegia/quadriplegia. An MRI scan would have detected the ligamentous injury and prevented mobilisation. The patient underwent delayed neurosurgical fusion but deteriorated with post-operative pneumonia and was managed palliatively, dying 10 days post-surgery. Key clinical lesson: MRI is superior to CT for detecting ligamentous cervical spine injuries, particularly in elderly patients with haematoma on imaging.