Case 24 - Anterior Arch C1 Fracture

Dr. Yousem has provided the following report as a sample report for your reference. It does not match the case reviewed in the video.

MRI OF THE CERVICAL SPINE WITHOUT IV CONTRAST

INDICATION: R/o central cord syndrome. Arm numbness/weakness

COMPARISON: Same day CT C-spine without contrast on 10/23/2020.

TECHNIQUE: Axial and sagittal MR imaging of the cervical spine was performed on a 1.5 Tesla magnet without IV contrast.

FINDINGS:

Prevertebral hematoma extending from C1 through T1, measuring up to 11 mm in greatest thickness at the C2-C3 disc space level.

Focal discontinuity of the anterior longitudinal to the ligament at C3 vertebral level. Posterior longitudinal ligament appears intact.T2 hyperintensity at the interspinous ligament at C3-4, suggestive of traumatic injury. Trace facet joint effusion at the right C3-C4 facet, without subluxation or dislocation, also suggestive of traumatic injury.

Focal T2 hyperintensity involving the central cord extending from C3-4 vertebra. Abnormal cord signal is also present at the C5-6 level with spinal stenosis.

No evidence of acute fracture. No evidence of traumatic listhesis. Vertebral heights are maintained. No extra-axial fluid collection.

Multilevel degenerative changes of the cervical spine, with prominent central canal stenosis at C3-C4, C5-C6 and C6-C7. On a level by level basis:

C2-C3: No spinal canal narrowing or neuroforaminal stenosis.

C3-C4: Severe spinal canal stenosis due to posterior disc bulge, and bilateral ligamentum flavum thickening, causing near complete effacement of the thecal sac and abutment of the ventral aspect of the spinal cord. Associated T2 hyperintensity within the cord at this level, detailed above. No significant bilateral neural foraminal stenosis.

C4-C5: Mild central canal stenosis due to posterior osteophyte formation. No significant bilateral neural foraminal stenosis.

C5-C6: Severe spinal canal stenosis due to posterior disc bulge and moderate ligamentum flavum thickening. Moderate bilateral neural foraminal stenosis.

C6-C7: Moderate central canal stenosis due to posterior vertebral osteophyte formation and mild ligamentum flavum thickening. There is a left paracentral disc herniation abutting against the spinal cord. Mild bilateral neural foraminal stenosis.

C7-T1: No spinal canal narrowing or neuroforaminal stenosis.

Visualized soft tissues of the neck are unremarkable. Major vascular flow voids are preserved.

IMPRESSION:

1. Focal disruption of the anterior longitudinal ligament at the C3 vertebral level. Associated prevertebral hematoma extending from C1 through T1, measuring up to 11 mm at the C3 vertebral level. Minimal high signal intensity is seen in the intervertebral disc at C3-4 seen best on series 4 image 9.

2. T2 hyperintensity at the central cord from the C3-C4 vertebra, suggestive of cord contusion in the setting of traumatic injury at this level.

3. Trace joint effusion at the right C3-C4 facet, without subluxation or dislocation. T2 hyperintensity at the C3-C4 interspinous ligament. Findings are suggestive of additional traumatic injury. Probable ligamentum flavum injury as well seen best on series 4 image 12 and towards the midline on series 5 image 25.

4. Multilevel degenerative changes of the cervical spine, detailed above.
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EXAMINATION: CT HEAD/BRAIN WO CONTRAST, CT C-SPINE WO CONTRAST COMPLEX

AMENDED RESULT PLEASE SEE BELOW

CLINICAL HISTORY: 58-year-old male s/p MVC upper extremity numbness, inability to move hands

COMPARISON: None available

TECHNIQUE: Contiguous axial images of the head and cervical spine were obtained without intravenous contrast. Reformatted images were also provided

FINDINGS:

CT head:

There is no acute intracranial hemorrhage, midline shift or sulcal effacement. No abnormal extra-axial fluid is identified. Ventricles are within normal limits and basal cisterns are maintained. No focal intraparenchymal lesion or acute large vascular territory infarction. Gray-white matter differentiation is preserved.

There is complete opacification of the bilateral frontal sinuses as well as ethmoid air cells and the left maxillary sinus with partial opacification right maxillary and sphenoid sinuses. There is hyperattenuating material noted within the sinuses.

Hyperattenuation can be seen in the setting of inspissated mucus however given the extent of hyperdense secretions, allergic fungal sinusitis in the differential. No fracture is identified, making hemorrhage less likely.

Soft tissues of the orbits and globes are unremarkable. No acute calvarial fracture is seen.

Mastoid air cells are clear.

CT C-spine:

No acute fracture or traumatic subluxation is identified. There is partial osseous fusion across the disc space C4-C5. Atlantooccipital and atlantoaxial alignment is maintained. The predental space is preserved and prevertebral soft tissues are within normal limits.

There is mild multilevel degenerative disc disease C2-C3, C3-4, C5-C6 and C6-C7. At C3-C4, there is a effacement of ventral CSF and mild ventral cord indentation. Multilevel facet and uncovertebral joint arthropathy results in varying degrees of foraminal stenosis, greatest at C5-C6 on the right.

Visualized soft tissues of the neck are within normal limits. Visualized lung apices are unremarkable.

IMPRESSION:

 SEE AMENDED RESULT BELOW

1. No acute intracranial abnormality. No acute posttraumatic sequela in the cervical spine.

2. Pansinus opacification with hyperdense secretions. No associated fracture is identified, making hemorrhage less likely. Extensive hyperdense secretions raises the possibility of allergic fungal sinusitis. Correlate with clinical examination.

3. Multilevel degenerative disc disease throughout the cervical spine as detailed above.

AMENDED RESULT

THIS REPORT HAS BEEN CHANGED FROM THE PRELIMINARY REPORT IN A WAY THAT MAY AFFECT TREATMENT.

Upon further review, there does appear to be focal prevertebral soft tissue fullness centered about the C3-C4 level resulting in ventral displacement of the retropharyngeal space, raising concern for prevertebral hematoma in the setting of recent trauma, which could indicate underlying ligamentous injury. No acute osseous injury is appreciated. MRI cervical spine would be useful for further evaluation if no contraindications exist.

Other findings as described in the preliminary result.