Case 26 - Jefferson Fracture, vertebral dissection

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

EXAMINATION: CT HEAD/BRAIN WO CONTRAST, CT C-SPINE WO CONTRAST COMPLEX, CT T-SPINE WO CONTRAST COMPLEX, CT L-SPINE WO CONTRAST COMPLEX

INDICATION: 58-year-old male presenting after fall from second story roof.

TECHNIQUE: CT of the head, cervical, thoracic and lumbar spine was obtained without intravenous contrast. Coronal and sagittal reformats were obtained.

COMPARISON: CT of the chest/abdomen/pelvis dated 12/31/2017.

FINDINGS:

CT HEAD:

No acute intracranial hemorrhage. No intracranial mass, extra-axial fluid, or midline shift. The gray-white matter differentiation is preserved. Atherosclerotic calcifications of the bilateral cavernous and paraclinoid ICAs.

Ventricles are symmetric and within normal limits. The basal cisterns are patent.

The orbits are symmetric and within normal limits. Secretions in the right maxillary sinus and opacification of several anterior ethmoid air cells. The mastoid air cells are clear.

Calvarium and skull base are intact.

CT CERVICAL SPINE:

Comminuted burst fracture of the C1 vertebral body with involvement of the bilateral anterior arch and right posterior arch. The left lateral mass is laterally displaced to a greater degree than is that on the right. The left posterior arch appears intact. There appears to be acute fracture of the anterior aspect of the right C1 transverse process (series 5, image 21). Hyperdense material anterior to the spinal cord at C1 concerning for epidural hematoma.

Minimally displaced fracture of the left C7 lamina (series 5, image 194) extending into the left inferior articular facet, and right C7 anterior vertebral arch (series 5, image 196).

Multilevel degenerative changes greatest at C4-C5 with apparent partial osseous fusion. Multilevel anterior and posterior osteophyte formation. Disc space narrowing.

CT THORACIC SPINE:

Minimally displaced fractures of the inferior endplate osteophytes at T12 and L1 of indeterminate chronicity.

Chronic appearing compression fractures of the T8 and T9 vertebral bodies with partial osseous fusion. Multilevel degenerative changes with disc space narrowing and osteophyte formation.

CT LUMBAR SPINE:

No definite acute traumatic injury. Multilevel degenerative changes with endplate osteophyte formation, disc degeneration, and intervertebral disc space narrowing.

Chronic bilateral pars defects at L5. 6 mm anterolisthesis of L5 on S1.

IMPRESSION:

CT HEAD:

1. No CT evidence of acute intracranial abnormality.

CT CERVICAL SPINE:

1. Comminuted fracture of the C1 vertebral body as described above. Further evaluation with MRI is recommended.

2. Hyperdense material anterior to the spinal cord at the level of C1-C2 concerning for epidural hematoma.

3. Fractures of the left lamina/facet and right anterior arch at C7.

CT THORACIC SPINE:

1. Multilevel degenerative changes as described above.

CT LUMBAR SPINE:

1. No definite evidence of acute traumatic injury.

2. Degenerative changes as described above, including bilateral chronic L5 spondylolyses, with associated anterolisthesis of L5 on S1.