Cervical Spine Trauma CT
Claim CME CreditPOINT OF CARE INFORMATION
This CME activity consists of the student reviewing the video of the professor reviewing the case as well as the associated DICOM image set related to the case in question.
Learning Objectives
As a result of participation in this activity, participants should be able to:
- Provide improved patient care.
- Greater knowledge of the imaging characteristics of the patient's disease.
- Understand a better approach to interpretation of studies.
Faculty Disclosure
Mehmet Albayram, MD, Ivan Davis, MD, Mariam Hanna, MD, Anthony Mancuso, MD, Ronald Quisling, MD, Dhanashree Rajderkar, MD, Priya Sharma, MD, Roberta Slater, MD and Joann Stamm, MBA have disclosed that they have no relevant financial relationships. No one else is a position to control content have any financial relationship to disclose.
CME Advisory Committee Disclosure:
Conflict of interest information for the CME Advisory Committee members can be found on the following website: https://cme.ufl.edu/disclosure/.
Continuing Medical Education Credit
Accreditation: The University of Florida College of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
Credit: The University of Florida College of Medicine designates this enduring material for a maximum of 0.5 AMA PRA Category 1 Credits. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
CA0872-Cervical Spine Trauma CT
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CA0872-Cervical Spine Trauma CT
Case ReportExam
Prior Study
1. There is an oblique fracture of the dens base with 2 mms posterolisthesis and a right C1-2 facet subluxation are consistent with a rotary type of dens injury.
2. The dens fracture is likey the result of the leveraging effects of the cervical spine from C2 through C5; the spine is not well seen below C5, because of overlying shoulder densities.
Findings
Cervical CT
There is a dens fracture that starts and ends at the dens gutter while crossing the dens base in coronal projection. However, the fracture line in lateral projection clearly runs obliquely upward (typical of a rotary mechanism), rather than a straight horizontal fracture line in both planes (typically of a hyperextension mechanism). There is 2 mms of dens posterolisthesis and 2 mms of diastasis in the fracture line, but, there is no posterior dens tilting. Nevertheless, this injury represents a Type-2 dens fracture complex, which is the result of increased vulnerability of the dens base caused by leveraging from dengenerative autofusion above and below the dens base.
There is minimal offset of the C1-2 facet surfaces more on the right than the left. However, there are fixed bridging osteophytes along the lateral joint margins indicating that this changes is chronic and related to degenerative autofusion, rather than being an acute facet injury. Additionally, there approximately 3 mm chronic, partially calcified pannus posterior to the dens, again indicating effects of chronic degenerative arthropathy. The spinal canal width is maintained within acceptable limits despite the 2 mm dens posterolisthesis and the upper cervical pannus formation.
The degenerative arthropathy has produced a chronic, fixed 2 mm anterolisthesis at C3-4 and produced a PLL traction spur at C5-6, which likely reaches the anterior surface of the spinal cord, correlate for neurologic symptoms in which case MR would be valuable.
There is evidence of restricted motion involving the discs from C3-7, and autofusion of the articular pillars C2-5 bilaterally. Additionally, there is degenerative autofusion across the atlanto-axial joint space. The multiple levels of dengenerative autofusions place the level of maximal spinal vulnerability at the base of the dens; hence the Type 2 dens fracture.
There is a 1 cm in diameter dural based mass adjacent to the right temporal bone, which has well delineated borders, and is partially calcified. It is likely a low grade meningioma, but arteriomegaly/aneurysm cannot be excluded without CTA or MRA.
There is substantial thyroid gland enlargement (affecting the right gland more than the left) consistent with goiter. Correlate clinically.
Other
No other additional abnormalities are evident.
Impression
2. Advanced degenerative osteoarthropathy is evident with bilateral articular facet autofusion C2-C5, disc space osteophytic autofusion C3-C7, advanced osteoarthropathy of the atlanto-axial joint with 3 mms of pannus formation adjacent to the dens.
3. Significant, mainly right sided, partially calcified, thyroid gland hypertrophy is evident with compression and left lateral displacement of the upper esophagus.
4. There is a right lateral, partially calcified, 1 cm in diameter dural-based mass, likely representing a low grade meningioma.
5. There is focal disc osteophyte hypertrophy out of proportion to other and with a focal PLL traction spur that projects into the spinal sufficiently to reach the anterior cord surface. MR may be considered, if there are neurologic symptoms present.
Recommendations
No recommendation
