Cervical Spine Trauma 02 - Clinical Case Summary
SuCA0028-Cervical Spine Trauma 02 - Clinical Case Summary
SuCA0028-Cervical Spine Trauma 02 - Clinical Case Summary
SummaryHistory
83 yo male with mechanical fall
Exams Performed
Cervical spine plain film; Cervical spine CT
Prior available imaging reports
Plain film cervical radiograph
1. 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.
Cervical spine CT
1. There is an oblique dens base fracture consistent with a rotary dens injury. There is minimal dens posterolisthesis
2. Advanced degenerative osteoarthropathy is evident with bilateral articular facet autofusion C2-C5, disc space osteophytic autofusion C3-C7, advanced osteoarthropathy of the atlanto-axial joint with 3 mms of pannus formation adjacent to the dens.
3. Significant, mainly right sided, partially calcified, thyroid gland hypertrophy is evident with compression and left lateral displacement of the upper esophagus.
4. There is a right lateral, partially calcified, 1 cm in diameter dural-based mass, likely representing a low grade meningioma
5. There is focal disc osteophyte hypertrophy out of proportion to other and with a focal PLL traction spur that projects into the spinal sufficiently to reach the anterior cord surface. MR may be considered, if there are neurologic symptoms present.
Cervical spine MR was not obtained
1. 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.
Cervical spine CT
1. There is an oblique dens base fracture consistent with a rotary dens injury. There is minimal dens posterolisthesis
2. Advanced degenerative osteoarthropathy is evident with bilateral articular facet autofusion C2-C5, disc space osteophytic autofusion C3-C7, advanced osteoarthropathy of the atlanto-axial joint with 3 mms of pannus formation adjacent to the dens.
3. Significant, mainly right sided, partially calcified, thyroid gland hypertrophy is evident with compression and left lateral displacement of the upper esophagus.
4. There is a right lateral, partially calcified, 1 cm in diameter dural-based mass, likely representing a low grade meningioma
5. There is focal disc osteophyte hypertrophy out of proportion to other and with a focal PLL traction spur that projects into the spinal sufficiently to reach the anterior cord surface. MR may be considered, if there are neurologic symptoms present.
Cervical spine MR was not obtained
Lessons to be Learned
1. This case demonstrates how motion segment restriction produces site of increased vulnerability to spinal injury.
2. This case demonstrates how there should always be a search for chronic abnormalities, which can cause spinal cord injury with very little trauma. In this case it is the PLL traction spur which projects posteriorly at least to the ventral spinal cord surface at C5-6. No MR is available to assess for cord injury.
3. This case demonstrates how there should always be a search for concurrent abnormalities that are not associated with trauma. In this case there is a calcified mass in the right lateral cerebellar area-likely a 10-12 mm meningioma.
2. This case demonstrates how there should always be a search for chronic abnormalities, which can cause spinal cord injury with very little trauma. In this case it is the PLL traction spur which projects posteriorly at least to the ventral spinal cord surface at C5-6. No MR is available to assess for cord injury.
3. This case demonstrates how there should always be a search for concurrent abnormalities that are not associated with trauma. In this case there is a calcified mass in the right lateral cerebellar area-likely a 10-12 mm meningioma.
