Case 27 - Jefferson Fracture on MRI

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

Indication: Status post fall off of a second story roof while cleaning his rains spout. Loss of consciousness. Fell onto his right neck. History of prior C3-C6 and T4-T10 spinal epidural abscess due to IV drug abuse. CT scan showed C1 burst fracture and C7 lamina fracture.

TECHNIQUE: MR images of the cervical and thoracic spine were performed before and after administration of gadolinium. In addition MR angiographic images through the neck were performed.

FINDINGS:

Cervical spine:

There is high signal intensity in the soft tissues associated with the C1 vertebra and extending into the paraspinal musculature. There is ligamentous thickening posterior to the odontoid process without cord compression. At the C3-4 level there is degenerative change which abuts on the anterior aspect of the spinal cord with associated central canal narrowing. Degenerative changes in the bone marrow are noted from C3-4 through the C6-7 levels. The C6 vertebra has high signal intensity within it on T2-weighted imaging possibly related to hemangioma of bone.

The superior endplate of T1 is depressed and there is associated bone marrow edema. Similar high signal intensity in the superior endplate of T2 is present likely stress injury.

The axial scans through the cervical spine show no evidence of cord signal abnormality. There is mild central canal narrowing at the C3-4 level from degenerative changes as described previously.

Thoracic spine:

As previously mentioned there is high signal intensity in the superior endplate of T1 which is mildly depressed as well as the superior endplate of T2 without depression. There is kyphosis deformity at the T8-9 level where there has been fusion anteriorly across the vertebral bodies. The T10 inferior endplate shows high signal intensity on FLAIR imaging anteriorly.

There is no evidence of cord compression. The signal intensity in the spinal cord is normal.

A small central disc herniation at the T4-5 level is present and there is a disc bulge at the T5-6 level and T6-7 level. Mild degenerative facet joint disease is present at T11-12 and T12-L1. Ligamentum flavum thickening at the T10-11 level is present.

MRA of the neck

There is absence of a flow void on the spin-echo images of the right vertebral artery with high signal intensity throughout its course. On the post gadolinium enhanced images the origin of the right vertebral artery is never identified. The right vertebral artery is small in size throughout its course with slight irregularity and narrowing at the C6 level but appears patent. However at the V3-V4 junction on the right side there is high-grade stenosis seen best on series 30 image 90.

The maximum intensity projection reconstructions show no evidence of stenosis at the common carotid artery origins. There is narrowing of the left vertebral artery at its junction with the subclavian artery which has mild proximal narrowing. The carotid bifurcation show no evidence of significant stenosis. The intracranial vessels are patent.

When compared to the CT scan from earlier in the day the fracture of C1 is not well demonstrated on the MRI scan but the edema around the C1 laterally and into the paraspinal musculature is visualized on STIR imaging. The focal high signal intensity in the posterior portion of C6 appears to be a bone cyst. The superior endplate depression of T1 is identified on the CT scanner. The kyphos deformity and fusion at T8-9 is again noted and is chronic in age.

IMPRESSION:

C1 burst fracture is poorly visualized on the MRI scan but the adjacent edema and extension into the paraspinal musculature is well seen.

Superior endplate T1 compression deformity and bone marrow edema compatible with acute fracture.

Bone marrow edema of the superior endplate of T2 compatible with stress injury.

Degenerative changes in the thoracic spine with prior bony fusion at T8-9 and associated kyphos deformity.

T10 bone marrow edema along the anterior inferior endplate could also be stress-related although on the CT scan it appears to be sclerotic and possibly of degenerative etiology.

Focal areas of right vertebral artery narrowing at the C6 level and at the C3-V4 junction. The latter could be secondary to the adjacent fracture at C1 on the right side but there does not appear to be wall hematoma to suggest a dissection.

Normal carotid artery anatomy with no evidence of stenosis and normal appearance to the left vertebral artery except at its origin from the left subclavian artery where there is stenosis.