Cervical Spine Trauma 07 - Clinical Case Summary
Cervical Spine Trauma 07 - Clinical Case Summary
Cervical Spine Trauma 07 - Clinical Case Summary
SummaryHistory
56 yo male auto accident (high on drugs and rear-ended a truck). Patient has significant neck pain.
Exams Performed
Cervical spine CT; Cervical spine MR
Prior available imaging reports
Plain film cervical radiographs are not available
Cervical CT
1. Two separate levels of cervical fractures are evident including: 1. a C5 distal spinous process fracture, and 2. a C7 mid-body, nondisplaced, compression fracture of the right articular pillar.
2. Additionally, the presence of a punctate calcification in the C3-4 anterior annulus, plus minimal anterolisthesis, and possible, prevertebral edema raise the possibility of an anterior disc or ALL injury; correlate on MR for an ALL injury.
3. This combination of findings are consistent with a hyperextension mechanism aggrevated by the C4-6 motion restriction from degenerative osteoarthritis. Whether there is an actual acute ALL injuries remains indeterminate on CT, and therefore, MR should be obtained for further evaluation.
Cervical spine MR
1. There are multilevel post traumatic acute injuries affecting the ALL at C3-4 and at C6-7, the right articular pillar at C7 and the spinous process at C5, as described above. There presence of prevertebral edema at the C3-4 level and at C6-7 along with posterior muscle edema in the upper cervical area are consistent with recent injury. This combination of findings is consistent with a hyperextension mechanism affecting the spine at two separate levels, because of restricted cervical motion at C2-3 and C4-6.
Cervical CT
1. Two separate levels of cervical fractures are evident including: 1. a C5 distal spinous process fracture, and 2. a C7 mid-body, nondisplaced, compression fracture of the right articular pillar.
2. Additionally, the presence of a punctate calcification in the C3-4 anterior annulus, plus minimal anterolisthesis, and possible, prevertebral edema raise the possibility of an anterior disc or ALL injury; correlate on MR for an ALL injury.
3. This combination of findings are consistent with a hyperextension mechanism aggrevated by the C4-6 motion restriction from degenerative osteoarthritis. Whether there is an actual acute ALL injuries remains indeterminate on CT, and therefore, MR should be obtained for further evaluation.
Cervical spine MR
1. There are multilevel post traumatic acute injuries affecting the ALL at C3-4 and at C6-7, the right articular pillar at C7 and the spinous process at C5, as described above. There presence of prevertebral edema at the C3-4 level and at C6-7 along with posterior muscle edema in the upper cervical area are consistent with recent injury. This combination of findings is consistent with a hyperextension mechanism affecting the spine at two separate levels, because of restricted cervical motion at C2-3 and C4-6.
Lessons to be Learned
1. The presence of osteopenia makes diagnosis of either bone or ligamentous inury significantly more difficult.
2. Any of the mechanism of injury can, concurrently, cause injuries at different spinal levels concurrently, especially when separated by restricted level of motion restriction.
3. MR is essential in the diagnosis of cervical spinal injury, when the CT findings of ligamentous or synovial capsular injuries are indeterminate. This is especially true when the patient has significant spinal pain.
2. Any of the mechanism of injury can, concurrently, cause injuries at different spinal levels concurrently, especially when separated by restricted level of motion restriction.
3. MR is essential in the diagnosis of cervical spinal injury, when the CT findings of ligamentous or synovial capsular injuries are indeterminate. This is especially true when the patient has significant spinal pain.