WIDI - CA0871-Cervical Spine Trauma Plain Film Radiograph

Cervical Spine Trauma Plain Film Radiograph

Claim CME Credit

0.5 CME Credit available on completion

POINT 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.

CA0871-Cervical Spine Trauma Plain Film Radiograph

History

83 yo male with mechanical fall.

Exam

Cervical Plain film xray

Prior Study

none available

Findings

Cervical Plain film xray

There is evidence of restricted motion related to age-related degenerative autofusion involving the disc spaces from C3-6, and the articular pillars C2-C5 bilaterally. The cervical spine below C5 is not clearly visualized, because of overlying shoulder density. The multiple levels of degenerative autofusions affecting both the articular facets and the discs places the level of maximal spinal vulnerability at the base of the dens.

The dens appears to be offset from the C2 body. The usual single line along the anterior cortical surface of C2 is dehiscent at the dens base consistent with a fracture of the anterior dens cortex. There appear to be two posterior margin lines near the dens base (rather than the normal of one) consistent with fracture offset related to an oblique dens fracture rather than a straight transection of the dens base. The right sided dens gutter bone cortex is dehiscent also indicating fracture. These findings are consistent with a Type 2 dens fracture, which includes a 2-3 mm posterior listhesis of the dens relative to C2 body.

The trans-oral AP radiograph demonstrates a sliding type of offset of the C1-2 facet surfaces toward the left, which could reflect head positioning. There is no widening of the width of either C1-2 facet spaces. The combination of a right facet capsular injury along with the oblique fracture of the dens base (double posterior dens marginal lines) would suggest a rotary type of injury.

Other

No other abnormalities are present other than cervical trauma and degenerative autofusions with leveraging of the dens base.

Impression

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.