76 yo male in MVC

Cervical spine CT; Cervical spine MR

Plain film cervical radiograph not available
 
Cervical spine CT
1. Chronic, likely unstable, nonunion of a Type -2 dens fracture. MR is suggested for evaluation for cord injury and any evidence of acute ligamentous strain.
2. There is cervical restricted motion from C3 to C7 due to age-related spondylosis. The spinal canal sagittal width in this area measures 9 mms.
3. There is foraminal constriction at C7-T1 and T1-2 mainly on the left related to bone osteophytes.
4. There is widening of the anterior disc width at C2-3 and C7-T1. But, whether this is a chronic effect from spinal leveraging or is in part related to acute disc injury is indeterminate; correlate with MR.
 
Cervical spine MR
1. A chronic, type-2, dens fracture is present without evidence of acute injury, nor significant change in canal width. There is right C1-2 joint effucion likely the result of chronic degenerative arthropahy, since there is no post traumatic soft tissue injury in the adjacent area.
2. There is evidence of a unsupected C7-T1 distractive anterior disc injury with both prevertebral and posterior soft tissue edema. Findings are consistent with an acute traumatic event superimposed on chronic disc changes from leveraging of the C7-T1 joint space. There is no local vertebral fracture. The spinal canal and cord remain normal. There is no vertebral offset.

1. MR is invaluable in distinquishing acute disc and synovial joint injuries based on the presence or absence of adjacent soft tissue post traumatic edema. 

2. Motion segment restriction results in leveraging effects, which increase the probablility of injury above and/or below the fusion bloc.

3. MR can differentiate which changes are lelated to chronic nonunion