0:01

The T of vitamin C and D refers to trauma.

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And with cervical spine trauma in particular,

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we can have abnormalities associated with fractures

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or hematomas, or ligamentous injuries.

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Here we have a STIR image.

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The STIR images are superior to the other pulse

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sequences for the demonstration of traumatic

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injuries to the ligaments.

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On the STIR image, we see the posterior laminar line

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manifested as the ligamentum flavum ligaments

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showing a break here at the C5-C6 level.

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So this dark line along the spinal laminar line should

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be continuous all the way through from

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cervical to the thoracic region.

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Here we see that there is a break in that ligament

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and that is secondary to trauma.

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So once again,

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I'm just going to point to this with our little red marker.

0:59

You'll notice also that there appears to be a discontinuity

1:02

in the spinous process of the C5 vertebra

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and potentially C4, as well.

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And in addition,

1:09

there's bright signal intensity in the interspinous

1:12

ligament. So these are the interspinous ligaments.

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These are constructed by the ligamentum flavum.

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And here we see some edema in the posterior musculature

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as well from this patient's trauma.

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We also want to look at the posterior

1:26

longitudinal ligament.

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The posterior longitudinal ligament runs along the

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posterior aspect of the vertebral bodies,

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and it, too, should be continuous.

1:35

We note here that there is a focal area where the

1:38

posterior longitudinal ligament is not present.

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That is a tear in the posterior longitudinal ligament.

1:45

Its importance is that we now have two column disease.

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When we refer to the columns of the spine,

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we refer to the anterior half of the vertebral bodies

1:57

and the anterior longitudinal ligament.

1:59

We refer to the posterior half of the vertebral

2:02

bodies in the posterior longitudinal ligament.

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And then we refer to the posterior ligamentous complex,

2:07

including ligamentum flavum and interspinous ligaments.

2:10

If you have two columns diseased,

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as we do here and here,

2:15

it implies that the spinal column can be...

2:18

that it's unstable, and therefore you would have to have surgical

2:23

stabilization of the spinal canal because you could have

2:27

a situation where the canal may slip anterior-

2:30

posterior and injure the spinal cord.

2:33

So two column disease.

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The vertebral bodies themselves are part of the column.

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So whenever we have a trauma cases,

2:40

we're looking also for defects within the vertebral

2:43

bodies and also edema within the vertebral bodies.

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In this case, we don't see any fractures.

2:49

The last ligament that we want to look for is the

2:52

continuous anterior longitudinal ligament.

2:56

And in this case, we don't see any bright

2:57

signal intensity breaks in the anterior-

3:00

longitudinal ligaments. So this is two-column disease,

3:02

not three-column disease.

3:04

Here's an example of trauma at the lumbar spine.

3:08

In the lumbar spine,

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the two most common types of fractures are fractures of

3:14

the transverse process and compression fractures.

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Fortunately,

3:19

although the transverse process fractures are more

3:21

common, they usually do not require surgical fixation.

3:26

And although they may cause pain,

3:29

there usually is not compromise of the nerve roots

3:32

or the potential for a cauda equina syndrome.

3:37

This patient has the fracture of the L3 vertebra, as

3:42

well as a little bit more subtle fracture of the L1

3:45

vertebra, and there is retropulsion of that vertebral

3:48

body fracture into the spinal canal.

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Once we have involvement of the posterior

3:53

aspect of this vertebral body,

3:55

we start to worry about a type of fracture

3:59

that is called a burst fracture.

4:02

And if there are posterior element involvement,

4:05

we call that a chance fracture.

4:08

On the axial scans,

4:09

not only do we see the fracture

4:11

of the anterior vertebra,

4:13

but you are seeing the fractures of the transverse

4:16

processes in the same patient.

4:19

Transverse process fractures have an association with

4:23

visceral injuries of abdominal organs, and therefore it's

4:28

very important that if you see transverse process

4:30

fractures, you'd be very careful at looking at the liver

4:33

and the spleen and the GI organs

4:35

for possible visceral injury.

4:37

Epidural hematomas are another of the extradural

4:41

traumatic lesions that can occur in the spine and this

4:45

also may lead to compression of the spinal cord.

4:48

In this case,

4:49

an unusual case of a patient who had an epidural

4:52

hematoma compressing these conus medullaris following

4:56

a lumbar puncture. In general, this is very unusual.

4:59

When we do see epidural hematomas after lumbar puncture,

5:02

it's usually in patients who are taking anticoagulant

5:05

or antiplatelet drugs or who have a coagulopathy.