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Case 31 - Facet Fracture, Vertebral Artery Occlusion

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0:01

I want to use this case to demonstrate the potential

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injury to the vascular structures with a cervical

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spine fracture. So looking at the sagittal scan,

0:12

we see that the C4 vertebra is slightly posterior

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displaced compared to the C5 vertebra.

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And we also see a small area of fracture along the inferior

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emplate with this fragment more posteriorly and

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inferiorly separating from the vertebral body.

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Not only that,

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but you also see this discontinuity in the inferior

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facet at the C4 level and the widening of the space here

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between the facets and the fracture

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line extending towards the pedicle

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of the vertebral body. On the contralateral side,

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again, not as widened,

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but there is that increased space between the facets.

1:01

This shows the narrowing of the spinal canal.

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So there is some spinal stenosis associated

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with the level of the injury.

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When we look at this case on the axial scan,

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one thing that is impressive is the soft tissue that is

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seen causing incredible amount of spinal stenosis.

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This soft tissue is actually a herniated disc.

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So remember that you can have fractures

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that are causing the patient to have pain,

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but you may also have an acutely herniated disc which

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is compressing nerve roots or the spinal cord,

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causing the injury to the patient and/or their pain.

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So this is marked spinal stenosis.

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If we had to measure the AP diameter

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here of the spinal canal,

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you'd note that we're only dealing with a

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3 mm length for the AP diameter.

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So spinal stenosis at the level of the fracture

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dislocation that is seen here.

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Not only that,

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but if we look at this raw data from the CTA

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and follow the left vertebral artery,

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we see that coming up at that level of the...

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just above the fracture,

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we're missing the vertebral artery on the left side.

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But not only that,

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the right vertebral artery is also missing.

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Here it is in the foramen transversarium.

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Now, it's gone.

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And here we have the tight stenosis

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at the level of the fracture.

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We're still missing the vertebral arteries

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bilaterally. And as we come up,

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you start to see them again as they are reconstituted

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from collateral vessels. So important findings.

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Number one,

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the potential of associated disc herniation with traumatic

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injury to the cervical spine as a source of the neck pain.

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Number two, severe spinal stenosis likely to cause the

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patient to have cord injury, secondary to the

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displacement of the fracture fragments.

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Number three, the absence of normal flow on the CTA of

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the vertebral arteries at the level of the spinal stenosis

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and the fracture dislocation. And the presence of the

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widening of the spaces between the facet joints.

Report

Faculty

David M Yousem, MD, MBA

Professor of Radiology, Vice Chairman and Associate Dean

Johns Hopkins University

Tags

Neuroradiology

Head and Neck

Emergency

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