Cervical Spine Trauma 01 - Clinical Case Summary
Cervical Spine Trauma 01 - Clinical Case Summary
Cervical Spine Trauma 01 - Clinical Case Summary
SummaryHistory
22 yo male in a T-boned car accident; patient ejected
Exams Performed
Cervical spine plain film; Cervical spine CT; Cervical spine MR
Prior available imaging reports
Cervical plain film
1. Plain film cervical radiograph was negative other than upper cervical toricollis.
Cervical CT
1. There are two levels of spinal injury. The upper cervical injury has evidence of a C2 osteoligamentous avulsion fracture with only minimal displacement, and bilateral minor superior process fractures. There are no posterior arch vertebral compressive fractures. There is no upper cervical malignment.
2. The second level of spinal injury is evident at C6 and C7. There is widening of the C6-7 posterior interspinous distance indicating ligamentous injuries of the spinolaminar ligament, and both the interlaminar and interspinous ligaments. There is a complex fracture involving the left portion of C7 extending into the left C7 pedicle. The fracture line has a spiral appearance consistent with a rotary type of injury. In addition, there are bilateral C7 inferior articular process fractures with evidence of capsular strain on the right and capsular tear on the left, as described above. There is no lower cervical malalignment to indicate injury to either the ALL or the PLL. The fracture complex at C2 and at C6/C7 are considered stable.
Cervical MR
1. MR confirmation of the C2 level, ALL, osteoligamentous, avulsion tear.
2. MR confirmation of the left C7 rotational fracture complex which includes a spiral fracture of the left part of the C7 body, the left C7 pedicle, and the inferior processes of both C7 articular processes. MR also confirms a PLL tear at C7, as well.
3. MR confirms the absence of spinal cord injury, acute HNP, or intraspinal hematoma.
4. MR identifies a soft tissue hematoma beneath the right sternocleidomastoid muscle. However, there is no apparent injury of the right ICA or jugular veins.
5. Despite 2 separate levels of significant spinal injury there is currently no malalignment nor significant change in spinal curvature. The C2 injury is stable. However, the C7 injury involve all 3 columns and is considered potentially unstable.
6. The C2 fracture is single column and likely stable. The C7 fracture complex is three column and considered unstable.
1. Plain film cervical radiograph was negative other than upper cervical toricollis.
Cervical CT
1. There are two levels of spinal injury. The upper cervical injury has evidence of a C2 osteoligamentous avulsion fracture with only minimal displacement, and bilateral minor superior process fractures. There are no posterior arch vertebral compressive fractures. There is no upper cervical malignment.
2. The second level of spinal injury is evident at C6 and C7. There is widening of the C6-7 posterior interspinous distance indicating ligamentous injuries of the spinolaminar ligament, and both the interlaminar and interspinous ligaments. There is a complex fracture involving the left portion of C7 extending into the left C7 pedicle. The fracture line has a spiral appearance consistent with a rotary type of injury. In addition, there are bilateral C7 inferior articular process fractures with evidence of capsular strain on the right and capsular tear on the left, as described above. There is no lower cervical malalignment to indicate injury to either the ALL or the PLL. The fracture complex at C2 and at C6/C7 are considered stable.
Cervical MR
1. MR confirmation of the C2 level, ALL, osteoligamentous, avulsion tear.
2. MR confirmation of the left C7 rotational fracture complex which includes a spiral fracture of the left part of the C7 body, the left C7 pedicle, and the inferior processes of both C7 articular processes. MR also confirms a PLL tear at C7, as well.
3. MR confirms the absence of spinal cord injury, acute HNP, or intraspinal hematoma.
4. MR identifies a soft tissue hematoma beneath the right sternocleidomastoid muscle. However, there is no apparent injury of the right ICA or jugular veins.
5. Despite 2 separate levels of significant spinal injury there is currently no malalignment nor significant change in spinal curvature. The C2 injury is stable. However, the C7 injury involve all 3 columns and is considered potentially unstable.
6. The C2 fracture is single column and likely stable. The C7 fracture complex is three column and considered unstable.
Lessons to be Learned
1. A negative plain film for fracture or ligamentous tear does not mean they are not there. They are just not visualized. With the history of a major traumatic event and torticollis CT should be obtained NOT flexion/extension plain films.
2. This case demonstrates how significant cervical injuries create a variety of mechanism. In this instance, there is predominantly a hyperextension vector causing the anterior C2 avulsion fracture and a rotational mechanism causing the C7 rotary injuries. Direct trauma to the occiput is the basis for the occipital skull fracture.
3. The value of thinking in terms of mechanism of injury is that all the potential associated bone and ligamentous and capsular injuries are investigated helping to avoid satisfaction of search errors
4. This case demonstrates the difference in stability assessment for each lesion
2. This case demonstrates how significant cervical injuries create a variety of mechanism. In this instance, there is predominantly a hyperextension vector causing the anterior C2 avulsion fracture and a rotational mechanism causing the C7 rotary injuries. Direct trauma to the occiput is the basis for the occipital skull fracture.
3. The value of thinking in terms of mechanism of injury is that all the potential associated bone and ligamentous and capsular injuries are investigated helping to avoid satisfaction of search errors
4. This case demonstrates the difference in stability assessment for each lesion