Cervical Spine Trauma 05 - Clinical Case Summary
Cervical Spine Trauma 05 - Clinical Case Summary
Cervical Spine Trauma 05 - Clinical Case Summary
SummaryHistory
56 yo female with chronic neck pain who fell on a boat, now with pain and subjective weakness
Exams Performed
Cervical spine plain film; Cervical spine CT; Cervical spine MR
Prior available imaging reports
Cervical spine radiograph
1. Focal rotary subluxation is evident at C6-7 consistent with an articular pillar injury; CT is recommended for further evaluation.
Cervical spine CT
1. The injury complex at C7 involves a combination of a left C7 lateral body fracture, a left comminuted fracture of the articular superior process, a left C6 inferior articular process tip fracture, plus an oblique fracture involving the outer cortex of the C7 pedicle and the C7 vertebral body (i.e. implying a rotary injury component). The fracture complex is likely stable.
2. There is a fracture through the left C7 foramen transversarium, which could contribute to a vascular injury.
Cervical spine MR
1. There is a rotary injury involving the left C7 articular superior process, the left lateral C7 body, and the left C7 pedicle. The fractures were all more apparent on the CT exam.
2. The left C7 superior process fracture is inferiorly displace enough to partially narrow the C6-7 neural foramen and there appears be some edematous swelling of the left C6 ganglion.
3. There is no vascular injury to the left vertebral artery, despite the fracture of the left C7 foramen transversarium.
4. There is a small volume, central disc, protrusion at C4-5 without cord signal change nor myelomalacia.
1. Focal rotary subluxation is evident at C6-7 consistent with an articular pillar injury; CT is recommended for further evaluation.
Cervical spine CT
1. The injury complex at C7 involves a combination of a left C7 lateral body fracture, a left comminuted fracture of the articular superior process, a left C6 inferior articular process tip fracture, plus an oblique fracture involving the outer cortex of the C7 pedicle and the C7 vertebral body (i.e. implying a rotary injury component). The fracture complex is likely stable.
2. There is a fracture through the left C7 foramen transversarium, which could contribute to a vascular injury.
Cervical spine MR
1. There is a rotary injury involving the left C7 articular superior process, the left lateral C7 body, and the left C7 pedicle. The fractures were all more apparent on the CT exam.
2. The left C7 superior process fracture is inferiorly displace enough to partially narrow the C6-7 neural foramen and there appears be some edematous swelling of the left C6 ganglion.
3. There is no vascular injury to the left vertebral artery, despite the fracture of the left C7 foramen transversarium.
4. There is a small volume, central disc, protrusion at C4-5 without cord signal change nor myelomalacia.
Lessons to be Learned
1. Superior articular process fractures, which are often a part or hyper rotational or hyperflexion injuries, can be inferiorly displaced into the adjacent neural foramen and cause post traumatic nerve injury.
2. Fractures of the transverse process and its' foramen transversarium can be associated with vertebral artery injuries.
2. Fractures of the transverse process and its' foramen transversarium can be associated with vertebral artery injuries.