Case 25 - Odontoid 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.

RESULT:

CT head/brain without contrast

CT cervical spine without contrast complex

CT thoracic spine with contrast complex

CT lumbar spine with contrast complex

HISTORY: Motor vehicle collision

TECHNIQUE: Noncontrast CT of the head and cervical spine is performed with sagittal and coronal reconstructions. CT angiography of the neck is performed after uneventful intravenous administration of contrast with MIP reconstruction. Reformatted images of the thoracic and lumbar spine were also provided from CT of chest abdomen and pelvis.

FINDINGS: No prior studies available for comparison.

Head CT:

No acute intra-axial or extra-axial fluid collection. Normal gray-white matter differentiation. Ventricles are of normal size and morphology. No midline shift or mass effect. The basal cisterns are patent. Scalp hematoma with laceration over the right forehead is noted. The moderate is mucosal thickening of the maxillary sinuses with mucous retention cyst in the right maxillary sinus. Mild thickening of the ethmoid sinuses is noted. There is depressed fracture of right zygomatic arch extending to the lateral and inferior wall of the right orbit, and anterior and lateral wall of the right maxillary sinus. The fracture extends through the infraorbital canal and inferior wall of the right orbit. Right facial and periorbital soft tissue swelling.

Cervical spine CT:

Alignment is normal. There is burst fracture (Jefferson fracture) of the C1 ring involving the anterior arch of C1 bilaterally left greater than right with 5 mm of displacement and distraction of the anterior arch of C1 on the left. Comminuted fractures of right posterior arch of C1 are also noted in. Occipital condyles are unremarkable, with maintained atlanto-occpital articulation. The C1-C2 articulation remains grossly intact. There is type II dens fracture with less than 2 mm distraction and no significant posterior displacement. Tiny subcentimeter osseous fragments are seen posterior to the dens fracture site, within the epidural space. Mild ventral epidural thickening posterior to C2, partially effacing the ventral thecal sac, however without significant spinal canal stenosis. Additional linear fracture through the C2 posterior spinous process.

CT angiography of the head and neck:

Bilateral vertebral, and carotid arteries are patent throughout the neck with no evidence of narrowing, or dissection. Right vertebral artery is slightly dominant. Vessels of anterior and posterior circulation are patent. The bilateral posterior communicating arteries are hypoplastic.

CT thoracic spine and lumbar spine:

Alignment is normal. Nondisplaced fractures of the superior endplate of the vertebral bodies of T4 and T5 noted in the right aspect, with no loss of height. Minimal distracted small fracture of the T5 spinous process tip. In addition, comminuted fracture of T6 vertebral body is noted with approximately 20% height loss. No retropulsion the spinal canal. The fracture extends to the left pedicle and lamina of T6 and involves the superior articular facet. Fractures also involve the right sided articular facets, and there is also a linear fracture through the left transverse process of T6. There is comminuted fracture of T7 vertebral body with approximately 30% height loss anteriorly. No retropulsion into the spinal canal.

No lumbar spine fracture is identified. The spinal canal and neural foramina are patent bilaterally at all thoracolumbar spine levels.

Additional fractures noted through the bilateral scapulae. Bilateral small pneumothoraces are noted. Small opacities in the posterior lungs, which likely reflect lung contusions. Heterogeneously perfused kidney which may be related to arterial phase of imaging. Small amount of free fluid in the pelvis.

IMPRESSION:

1. No acute intracranial bleed. Right scalp laceration and hematoma.

2. Depressed fracture of the right zygomatic arch extending to the anterior and lateral walls of the right maxillary sinus, and lateral and inferior wall of the right orbit involving the infraorbital canal.

3. Comminuted Jefferson burst fracture of C1 with 5 mm distraction and displacement of the anterior arch of C1 on the left. The C1-C2 articulations remain intact.

4. Type II dens fracture with tiny osseous fragments retropulsed into the epidural space. Mild epidural thickening posterior to C2. Underlying small amount of epidural hematoma is possible, although no significant spinal canal stenosis is present. Can further evaluate with MRI. Additional linear C2 spinous process facture.

5. Unremarkable CT angiography of the head and neck. Vertebral and carotid arteries are patent without dissection or aneurysm.

6. Comminuted fractures of T6 and T7 vertebral bodies with height loss anteriorly most significant at T7 with 30% height loss. Fractures of T6 extend into the left greater than right posterior elements as detailed above. No retropulsed osseous fragment in the spinal canal. Small fractures of the vertebral bodies are noted at right aspect of T4 and T5 vertebral bodies with no height loss. Bilateral scapular fractures, partially imaged.

7. No lumbar spine fracture. 8. Bilateral small hydropneumothoraces, and small posterior lung contusions. Small amount of free fluid in the pelvis. Correlate with dedicated CT chest/abdomen/pelvis.