Cervical Spine Trauma 08 - Clinical Case Summary
Cervical Spine Trauma 08 - Clinical Case Summary
Cervical Spine Trauma 08 - Clinical Case Summary
SummaryHistory
52 yo male who slipped & fell in bathroom at night
Exams Performed
Cervical spine CT; Cervical spine MR
Prior available imaging reports
Plain film cervical radiographs are not available
Cervical CT
1. Comminuted fractures of the anterior portion of the C6 vertebral, as described above, could represent a rotational spine injury, but because of the C6 osteophytes restricting motion above and below C6, these fractures could be a form of hyperextension distractive injury.
2. There is a widened left C3-4 uncovertebral joint on the left of indeterminate significance; MR should be obtained to exclude ALL ligamentous injury.
3. The combination of disc spondylosis and articular pillar degenerative changes increase spinal vulnerability (during abnormal motion) at C3-4 and at C6.
4. Posterior disc osteophytes narrow the spinal canal to 6.3 mms; MR should be obtained to exclude canal compression or acute injury. They also produce foraminal narrowing at C5-6 bilaterally.
5. Underlying expansile cystic bone lesion is evident at C6 involving the posterior arch and the right articular pillar.
Cervical spine MR
1. ALL and anterior C3-4 disc distractive injuries are evident with associated spinal cord edema at the same level.
2. An acute oblique fracture of the anterior part of the C6 vertebral is present without retropulsed bone fragments. This type of fracture usually suggests a rotational injury, however, C6 was leveraged by adjacent bridging osteophytes, which made it vulnerable to a hyperextension distractive injury to the vertebral body rather than just the usual osteoligamentous avulsion fracture. With the additional abnormalities including a C3-4 distractive ALL/disc injury and a hyperextension type right articular pillar compression fracture, the entire complex can be explained by a hyperextension mechanism. The spinal injuries are not likely to be unstable, but the evidence of spinal cord edema would suggest that any cervical motion adds risk. Therefore, the injury should be considered unstable.
3. There is an occult C6 posterior arch bone cyst with nonaggressive features.
Cervical CT
1. Comminuted fractures of the anterior portion of the C6 vertebral, as described above, could represent a rotational spine injury, but because of the C6 osteophytes restricting motion above and below C6, these fractures could be a form of hyperextension distractive injury.
2. There is a widened left C3-4 uncovertebral joint on the left of indeterminate significance; MR should be obtained to exclude ALL ligamentous injury.
3. The combination of disc spondylosis and articular pillar degenerative changes increase spinal vulnerability (during abnormal motion) at C3-4 and at C6.
4. Posterior disc osteophytes narrow the spinal canal to 6.3 mms; MR should be obtained to exclude canal compression or acute injury. They also produce foraminal narrowing at C5-6 bilaterally.
5. Underlying expansile cystic bone lesion is evident at C6 involving the posterior arch and the right articular pillar.
Cervical spine MR
1. ALL and anterior C3-4 disc distractive injuries are evident with associated spinal cord edema at the same level.
2. An acute oblique fracture of the anterior part of the C6 vertebral is present without retropulsed bone fragments. This type of fracture usually suggests a rotational injury, however, C6 was leveraged by adjacent bridging osteophytes, which made it vulnerable to a hyperextension distractive injury to the vertebral body rather than just the usual osteoligamentous avulsion fracture. With the additional abnormalities including a C3-4 distractive ALL/disc injury and a hyperextension type right articular pillar compression fracture, the entire complex can be explained by a hyperextension mechanism. The spinal injuries are not likely to be unstable, but the evidence of spinal cord edema would suggest that any cervical motion adds risk. Therefore, the injury should be considered unstable.
3. There is an occult C6 posterior arch bone cyst with nonaggressive features.
Lessons to be Learned
1. MR should be obtained whenever there is any suspicious evidence of ligamentous damage (i.e. the widened left uncovertebral joint at C-4 in this case).
2. The levels of any spinal injury is usually based on vulnerability sites created by motion segment restrictions. In this case hyperextension produced an usual distractive C6 anterior vertebral body fracture, be cause the C6 body ALL insertion sites had dens osteophytes.
3. Leveraging can produce a variety of injuries with any mechanism. We need to be open to adding MR whenever any suspicious or unexpected joint, disc, or bone injury is present.
2. The levels of any spinal injury is usually based on vulnerability sites created by motion segment restrictions. In this case hyperextension produced an usual distractive C6 anterior vertebral body fracture, be cause the C6 body ALL insertion sites had dens osteophytes.
3. Leveraging can produce a variety of injuries with any mechanism. We need to be open to adding MR whenever any suspicious or unexpected joint, disc, or bone injury is present.