0:01

This was the patient that we demonstrated earlier with the

0:04

Jefferson fracture of C1, a burst fracture of C1.

0:09

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

0:11

was that it did look like there was some endplate,

0:14

depression and irregularity along the

0:17

superior endplate of the T1

0:18

vertebra. We weren't really sure whether

0:21

this was just an elderly patient.

0:23

You can see that there's quite a bit

0:24

of DJD with degenerative change,

0:27

but we were concerned about the presence of the superior

0:31

endplate, what looked like fragmentation at T1.

0:35

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

0:39

This is the MRI scan on the patient

0:42

that had the Jefferson fracture.

0:44

And we had previously looked at the high signal intensity at

0:48

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

0:54

What we didn't pay attention to was the signal

0:56

intensity of the superior endplates of

1:00

T1, and in point in fact, T2.

1:02

This bright signal intensity in these superior

1:04

endplates likely represents bone edema,

1:07

and in this particular individual, was seen to

1:09

correspond with a fracture of that superior endplate.

1:13

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

1:17

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

1:19

was the T2 level had the same injury.

1:22

So this may just be bone strain or stress injury

1:27

to the superior endplate. At the T1 level,

1:30

we actually saw the bone fragmentation of the

1:32

superior endplate, and it was a true fracture.

1:35

So use these STIR images.

1:37

They're quite useful.

1:38

When you're seeing these abnormalities,

1:40

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

1:43

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

1:49

This ends up just being a small hemangioma of the

1:52

vertebral body that was seen on the CT scan.

1:56

So compression fracture, superior endplate

2:00

of T1, as well as stress injury without fracture,

2:04

superior endplate of T2 in association

2:08

with the Jefferson burst fracture.

Case 34 - Compression Fracture & Stress Injury

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