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Case 34 - Compression Fracture & Stress Injury

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This was the patient that we demonstrated earlier with the

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Jefferson fracture of C1, a burst fracture of C1.

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One thing that we didn't point out in the same case

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was that it did look like there was some endplate,

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depression and irregularity along the

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superior endplate of the T1

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vertebra. We weren't really sure whether

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this was just an elderly patient.

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You can see that there's quite a bit

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of DJD with degenerative change,

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but we were concerned about the presence of the superior

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endplate, what looked like fragmentation at T1.

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So let's look at the MRI scan on this individual.

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This is the MRI scan on the patient

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that had the Jefferson fracture.

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And we had previously looked at the high signal intensity at

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the occipital condyle C1 level and the C1-C2 level.

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What we didn't pay attention to was the signal

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intensity of the superior endplates of

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T1, and in point in fact, T2.

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This bright signal intensity in these superior

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endplates likely represents bone edema,

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and in this particular individual, was seen to

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correspond with a fracture of that superior endplate.

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So not just at the C1 level, but also at the T1 level.

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And what we didn't appreciate on the CT scan,

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was the T2 level had the same injury.

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So this may just be bone strain or stress injury

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to the superior endplate. At the T1 level,

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we actually saw the bone fragmentation of the

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superior endplate, and it was a true fracture.

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So use these STIR images.

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They're quite useful.

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When you're seeing these abnormalities,

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you might also say, well, what about over here?

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So this is the 2, 3, 4, 5, C6 posterior elements.

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This ends up just being a small hemangioma of the

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vertebral body that was seen on the CT scan.

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So compression fracture, superior endplate

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of T1, as well as stress injury without fracture,

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superior endplate of T2 in association

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with the Jefferson burst fracture.

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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