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.
CA0894-Cervical Spine Trauma MR
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CA0894-Cervical Spine Trauma MR
Case ReportExam
Prior Study
Cervical CT
1. There is a chronic, likely unstable, nonunion of a Type -2 dens fracture. MR is suggested for evaluation for cord injury and any evidence of acute ligamentous strain.
2. There is cervical restricted motion from C3 to C7 due to age-related spondylosis. The spinal canal sagittal width in this area measures 9 mms.
3. There is foraminal constriction at C7-T1 and T1-2 mainly on the left related to bone osteophytes.
4. There is widening of the anterior disc width at C2-3 and C7-T1. But, whether this is a chronic effect from spinal leveraging or is in part related to acute disc injury is indeterminate; correlate with MR.
Findings
Cervical spine MR
There is evidence of a chronic type-2 dens fracture with 3 mms of pannus posterior to the dens, similar that on CT. There is not appreciable acute edema in the fracture line to indicate a recent injury. The canal width at the C2 levels measures 8.1 mms, which is smaller than evident on CT, but the cord signal remains normal and there is no cord compressive deformity at this level.
There is evidence of 2-3 mms of posterior subluxation of the C1-2 synovial joints, as evident on CT. However, there is no effusion in these joint spaces to suggest acute injury.
The posterior osteophytic ridge at C3-4 narrows the sagittal canal width to 6 mms and does cause cord deformity, but, the cord signal remains within normal limits and there is no apparent myelomalacia. The spinal canal is narrowed to 6.4 mms at C7-T1 with minimal cord flattening, but no cord signal change.
There is posterior paraspinous soft tissue edema in the lower cervical area from recent injury. There is also minimal, but abnormal prevertebral edema at the C6-T2 level. There is increase T2-w signal in the C7-T1 disc space with minimal widening of the anterior disc width, as seen on the CT. The disc changes could be chronic leveraging effects, however, with the prevertebral and posterior paraspinal edema, it is likely this is in part an acute hyperextension distractive injury. The ALL is intact and there is no vertebral offset; the spine in this areas is likely stable.
There was an apparently healed compression fracture of the superior end-plate of T2 on CT. There is no abnormal MR signal present indicating that this fracture is old and not of current relevance.
Other
No other abnormalities are present other than cervical trauma.
Impression
2. There is evidence of a unsupected C7-T1 distractive anterior disc injury with both prevertebral and posterior soft tissue edema. Findings are consistent with an acute traumatic event superimposed on chronic disc changes from leveraging of the C7-T1 joint space. There is no local vertebral fracture. The spinal canal and cord remain normal. There is no vertebral offset.
Recommendations
No recommendation
