Cervical Spine Trauma MR
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.
CA0889-Cervical Spine Trauma MR
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CA0889-Cervical Spine Trauma MR
Case ReportExam
Prior Study
1. There is a rotary injury to C2 vertebral body splitting the C2 body into two sections. One section is subluxed anteriorly, while the other remains in expedected position. The fracture complex is considered unstable.
Cervical CT
1. There is a rotary spiral fracture present which splits the C2 body into two portions. The left portion is subluxed anteriorly and significantly rotated such that the broken left pars intermedia projects into the left part of the spinal canal with putting the spinal cord at traumatic risk.
2. There is a nondisplaced superior end-plate C3 compression fracture (likely an axial loading injury)
Findings
Cervical spine MR
CT had demonstrated a complex spiral fracture with splitting of the C2 body into two portions. The left portion is subluxed anteriorly and significantly rotated such that the broken left pars intermedia projects into the left part of the spinal canal. MR demonstrates some reduction in spinal canal size in the region of the fracture, but there is enough space for the spinal cord to traverse without compression nor evidence of traumatic injury at the C2 level. However, there is subtle spinal cord signal change at C6 suggesting either early myelomalacic change or possibly acute cord edema. In this case there is no overt spinal injury, but there is canal stenosis. Conceivably, exaggerated cervical motion could have produced a focal cord contusion; no blood products are evident.
There is edema in the fracture line of the C2 fracture and the C3 superior end-plate fracture. There is prevertebral edema from C2-4. There is edema in the posterior upper cervical muscles indicating post traumatic strain. There is bone edema beneath the end-plates of C4 and C5 considered nontraumatic, but related to degenerative spondylosis.
Despite the fractured foramina transversaria there is no apparent post traumatic arterial dissection. The left vertebral artery is dominant and the right vertebral is quite small. There lumen of the right vertebral artery has increased signal likely reflecting slower flow rate in the portion going through the distorted foramen transversarium, but it appears patent before and after.
The C2 fracture complex is considered unstable.
Other
No other abnormalities are present other than cervical trauma.
Impression
2. There is a developmentally dominant left vertebral artery and a hypoplastic right vertebral artery. Neither appear to have been dissected nor occluded. The right vertebral artery demonstrates signal change from slowed flow in the region of the fractured C2 foramen transversarium.
Recommendations
No recommendation
