Cervical Spine Injury After Virtual Reality Gaming

A Case Report

D. Baur; C. Pfeifle; C. E. Heyde


J Med Case Reports. 2021;15(312) 

In This Article

Case Presentation

The Caucasian patient presented to our university clinic with pain and swelling in the lower cervical spine. Before the pain occurred, the patient was playing a VR video game involving combinations of shoulder, arm and head movements to rhythmic visual and musical triggers. He felt sudden pain between his shoulder blades while playing and turning his head rapidly. The patient was not able to point out the exact movement that led to the pain. He reported no falls or collisions with his surroundings. Neurological deficits were not present when he was first admitted to our hospital. Preexisting comorbidities were not present in the 31-year-old male. No history of regular medication use or drug abuse was recorded. The pain level was bearable without painkillers (visual analog scale [VAS] score 3–4). No other injuries or deformities of the spine were detected in the medical records. The only prerecorded injury was a patellar fracture without impact on the momentary resilience or range of motion of the affected joint. No fever or other inflammatory symptoms were present. In anamnesis, the patient claimed to play VR games for 1 to 4 hours on an almost daily basis.

After the clinical examination and radiological diagnostics via computed tomography (CT) and conventional X-ray scans of the cervical spine, we found a dislocated traumatic fracture of the spinous process of the seventh cervical vertebra (C7:A0 according to the AO classification system)[7] (Figures 1, 2). For comprehensive diagnostics, a magnetic resonance imaging (MRI) scan of the cervical spine was carried out. The MRI findings showed neither signs of soft tissue edema around the fracture nor spinal stenosis. Furthermore, no rupture of the anterior or posterior longitudinal ligament was detected (Figure 3)

Figure 1.

Lateral neck X-ray taken at admission. X-ray, computed tomography and magnetic resonance imaging taken from patient folder with the patient's consent

Figure 2.

Lateral magnetic resonance imaging (MRI) turbo inversion recovery magnitude (TIRM) sequence. X-ray, computed tomography and MRI taken from patient folder with the patient's consent

Figure 3.

Lateral computed tomography (CT) scan, X-ray, CT and magnetic resonance imaging taken from patient folder with the patient's consent

Additionally, due to the unusual trauma mechanism, we conducted laboratory investigations to exclude the possibility of preexisting osteoporosis.

The patient showed no signs of osteoporosis in the blood tests, with normal levels of serum 1,25-hydroxyvitamin D (vitamin D), parathyroid hormone (PTH), ß-CrossLaps and alkaline bone phosphatase. The CT scan showed normal bone density in the seventh cervical and surrounding vertebrae, as a mean of 315 Hounsfield units (HU) was measured. To limit radiation exposure, we did not perform a dual-energy X-ray absorptiometry (DEXA) scan.[8,9] The patient received a conservative therapy regimen with pain therapy and immobilization of the cervical spine in a semirigid collar.[10] During hospitalization, the patient recovered under conservative treatment, and no signs of neurological deficits were present at any time.

After concluding diagnostics, the patient was discharged with outpatient treatment.

After hospitalization, outpatient controls were conducted at 4, 6 and 12 weeks. The patient had a good general condition throughout the recovery process, without additional symptoms. After 4 weeks, the patient no longer needed pain medication.

The radiological controls showed no further dislocation of the fracture, and the patient tapered the use of the semirigid collar at 6 weeks after trauma.

He showed no hypermobility or pain during fast movements of the cervical spine, with full range of motion. In the following 6 weeks, no pain or neurological deficits were reported by the patient. After 12 weeks, the patient was active and was able to return to sports.