Info Images Findings Impression Reco/Acuity Case Images View Images / Launch Visage Case Notes History 83 yo male with mechanical fall Exam Cervical spine CT Prior Study Plain film cervical radiograph Dicom View Reference Material
Section 1 Submit Findings C402b Findings Underlying conditions increasing vulnerability to post traumatic injury There are levels of restricted motion (hyposegmentation anomalies, operative fusions or acquired autofusions) Yes No There are abnormal developmental anomalies affecting the C1 ring, C2 pars, and the dens Yes No There is evidence of chronic arthropathy disorders affecting the spinal canal width (PLL traction spurs, OPLL, DISH, CPPD) Yes No There is evidence of underlying inflammatory arthropathy possibly increasing or decreasing spine mobility (JRA, RA, psoriatic arthritis, etc.) Yes No There is underlying bone pathology not related to trauma, but which could have a pathologic fracture Yes No Ligamentous injuries There is abnormal widening of dens tip to basion distance (or avulsion fracture of the clival tip) indicating apical ligament disruption Yes No There is abnormal malalignment of the cervical canal with the foramen magnum Yes No There is an abnormal X-lines indicating the dens is abnormally displaced Yes No There is widening of one or both occipital condyles to C1-lateral mass joint space widths indicating occip-cervical injury (2x average width = ligamentous injury) Yes No There is abnormal widening of the atlanto-axial distance indicating transverse ligament disruption Yes No There is lilting of dens relative to C2 and/or avulsion fracture off the C1 ring indicating alar ligament disruption Yes No There is widening of one or both occipital condyles to C1-lateral mass joint space widths and/or facet surface offset indicating occip-cervical injury (2x average width = ligamentous injury) Yes No There is widening of the width of C1-2 facet spaces indicating capsular injury (2x average width = ligamentous injury) Yes No There is widening of the width of C2-3 facet spaces consistent with facet capsular injury (2x average=injury) Yes No Bone fractures and/or other injuries There is fracture of either occipital condyles; include assessment of an occipital bone fracture extending into the condyle Yes No There is a fracture of the C1 ring, or there is bilateral translational offset of the lateral masses of C1 relative to C2 (in AP plane) also consistent with a C1 ring fracture (or Jefferson's Fx) even if the fracture line is not discernible Yes No There is fracture of the dens (3 types) Yes No There is abnormal cortical rim fracture or medullary buckle or compression in the C2 body indicating fracture, especially at subdental synchondrosis Yes No Underlying conditions increasing vulnerability to post traumatic injury There are levels of restricted motion (hyposegmentation anomalies, operative fusions or acquired autofusions) Yes No There are abnormal developmental anomalies affecting the C1 ring, C2 pars, and the dens Yes No N/A There is evidence of chronic arthropathy disorders affecting the spinal canal width (PLL traction spurs, OPLL, DISH, CPPD) Yes No There is evidence of underlying inflammatory arthropathy possibly increasing or decreasing spine mobility (JRA, RA, psoriatic arthritis, etc.) Yes No Hyperflexion injuries (below C2): Compressive side anterior to the fulcrum There is compressive buckle or fracture of the anterior vertebral body beginning at the fulcrum Yes No There is compressive fracture of one side of the vertebral body indicating a lateroflexion vector Yes No Hyperflexion injuries (below C2): Distractive side posterior to the fulcrum There is widening of posterior disc space width (PLL tear) Yes No There is a posterior vertebral body corner avulsion fracture (Sharpey fiber insertion site) Yes No There is malalignment & widening of the facet joint(s) Yes No There is fracture(s) of the articular processes Yes No There is widening of the interlaminar & interspinous distances (2x average width = ligamentous injury) Yes No The articular process fracture are displaced into foramen transversarium; r/o vertebral artery injury Yes No Hyperextension injuries (below C2): Compressive side posterior to the fulcrum There is no posterior arch compressive fractures (i.e. lamina, pedicle, or spinous processes Yes No There is a compressive articular body fracture(s) (compression or burst) Yes No There is malalignment of the facet joint(s) surfaces associated with the articular body compression fracture nor are there any bone fragments displaced into either the spinal canal or neural foramina Yes No There is abnormal reduced interlaminar/interspinous distances or overlaping of the spinous processes. Yes No Hyperextension injuries (below C2): Distractive side anterior to the fulcrum There is widening of anterior disc space width (with likely a ALL tear) Yes No There is a anterior vertebral body corner avulsion fracture (Sharpey fiber insertion site bone avulsion with potential ALL tear) Yes No There is an abnormal interlaminar and/or interspinous distances suggesting ligamentous injury. Yes No Rotational injuries There is a spiral or oblique fracture of either the dens alone (type 2 dens fracture) or the dens plus the C2 vertebral body (type 3 dens fracture), which would suggest injury on a rotational basis rather the a hyperextension mechanism. Yes No There is a spiral type of oblique vertebral body fracture, which may extend into the adjacent pedicle for cervical vertebral bodies C3 and below. Nor is there evidence of long axis splinter fracture of any lamina Yes No There is unilateral capsular injury for the condylar C1/C2 joint space or the C1-2 joint space Yes No There is significant change in the degree of spine rotation at one motion segment based on the position of the articular pillars Yes No There is increased width of one or more unilateral uncovertebral joints to suggest a rotary discal injury Yes No There is a combination of a unilateral articular pillar injury on the same side as the widened uncovertebral joint Yes No Axial-loading injuries There is compression injury to the vertebral bodies with buckling, comminuted fractures or actually burst/crush fractures. Yes No There is compression injury to the central portion of one or more vertebral end-plates Yes No There is compressive hyperdensity in the medullary trabecular bone Yes No There is compression on one side of one or more vertebral bodies or just one of the articular pillars indicating a lateroflexion mechanism Yes No Shear injuries There is a single level transsection injury to the spine causing a combination of fractures, disc,/articular capsular ligament tears Yes No There is underlying spinal fusion predisposing to shear injuries (i.e. ankylosing spondylitis, JRA, long segment spinal operative fusion) Yes No Additional injury observations There abnormal translational spinal alignment (anterolisthesis, posterolisthesis, or lateral listhesis) Yes No There is abnormal single motion segment rotational subluxation, usually related to a unilateral articular pillar fracture with rotary offset and possibly perched or locked facets Yes No There is focal spinal angulation (focal kyphosis-gibbus deformity) Yes No There is evidence of injury vectors with more than one mechanism Yes No There are injuries at more than one level Yes No The columns of stability exceed more than one, indicating the spine is potentially unstable Yes No Bone fragments are retropulsed into one or more neural foramina, indicating the nerve root or nerve root sleeve may be at risk Yes No Bone and/or disc fragments are retropulsed into the spinal canal, indicating the spinal cord is at risk Yes No Bone and/or disc fragments are retropulsed into the foramen transversaria raising the risk of vertebral arterial injury Yes No There is swelling in the carotid sheath raising the risk of cartoid arterial injury Yes No Other No other significant imaging findings are present. Yes No