Wk 5, Case 1 - Review

Patient History
Fall with concern for cervical spine trauma.

Findings
CT Cervical spine:

Acute mildly distracted right pedicle fracture of C7 with jumped/dislocated C6 inferior articulating facet with regard to the C7 superior articulating facet. The comminuted fracture likely extends to the right transverse foramen, although there is some artifact in this region. Acute comminuted mildly distracted fracture through the left C7 pedicle extending into the articular pillar with comminution and mild displacement of the superior articulating facet fracture component more than inferior articulating facet component. There is no significant associated spondylolisthesis at C6-C7. There is widening of the C6-C7 interspinous interval and mild anterior offset of the spinolaminar line on the right at C6-C7.

Irregularity of the anterior superior T1 endplate, with no definite acute fracture lucency identified, although evaluation is limited due to post observation and motion artifact.

No prevertebral edema.

Degenerative changes: Posterior osteophytic spurring and disc bulging contributing to varying degrees of mild to moderate canal stenosis, most prominent at C5-C6, where it is moderate. Multilevel uncovertebral and facet hypertrophy contributing to marked right and moderate left foraminal stenosis at C3-C4, marked right and mild left foraminal stenosis at C4-C5, and marked bilateral foraminal stenosis at C5-C6.

Normal thyroid, submandibular glands and parotid glands.

Partially imaged groundglass opacities in the upper lungs.

Additional findings: Multifocal calcific atherosclerosis.

Impressions
Acute bilateral C7 pedicle fractures, with comminution and extension into the left C7 articular pillar and left C6-C7 and C7-T1 facet joints. There is comminuted extension through the right transverse foramen at C7. Jumped right C6-C7 facets without significant spondylolisthesis.

Anterior superior endplate deformity of T1 may simply reflect osteophytic change, but is poorly evaluated due to artifact and mild compression fractures not excluded.

Findings
MR:

Redemonstrated acute fractures of the bilateral C7 pedicles with jumped right C6-C7 facet joint and fracture of the articular pillar on the left with subluxation.

Extensive T2/STIR hyperintensity within the posterior paraspinal soft tissues and along the interspinous regions most prominent at the C6-C7 level and to a lesser degree at C5-C6 and C7-T1. Minimal linear T2 hyperintensity in the prevertebral region.

Attenuated appearance of the posterior longitudinal ligament at the C6-C7 level with corresponding increased C6-C7 interspinous interval (for example seen on image 9-10 of series 3). Trace amount of fluid signal just dorsal to the posterior longitudinal ligament at this level may represent trace extra-axial blood product (seen on image 9 of series 5 closed).

T1 hypointensity along the anterior superior T1 vertebral body with
corresponding T2/STIR hyperintensity, likely representing bony contusion. No other evidence of acute vertebral body fracture or height loss in the other cervical vertebrae. There is chronic appearing inferior endplate deformity and sclerosis at the C5 level with osteophytic spurring.

The cervical cord is mildly indented along its ventral surface at multiple levels related to degenerative spondylotic changes, but no abnormally increased T2 signal is identified throughout the cervical spinal cord. No frank spinal cord compression is noted although there is degenerative spinal canal narrowing.

C2-C3: No spinal canal narrowing or right foraminal stenosis. Hypertrophic facet arthropathy is present with mild left foraminal narrowing..

C3-C4: Mild spinal canal narrowing related to circumferential disc bulging and ligamentum flavum thickening. Mild bilateral neuroforaminal stenosis due to uncovertebral and facet hypertrophy.


C4-C5: Mild to moderate spinal canal narrowing due to circumferential disc bulging with small central protrusion. Moderate right and mild left neuroforaminal stenosis due to uncovertebral and facet hypertrophy, more on the right.

C5-C6: Moderate to severe spinal canal narrowing due to circumferential disc bulge with broad-based central protrusion, with endplate osteophytic spurring that is better seen on prior CT. Severe bilateral neuroforaminal stenoses due to uncovertebral
hypertrophy and extension of disc bulging.


C6-C7: Circumferential disc bulging without significant central spinal canal narrowing. Mild right and moderate left neuroforaminal stenosis due to uncovertebral hypertrophy.


C7-T1: No significant neural foraminal stenosis or spinal canal narrowing.

Tiny T1 hyperintense foci along the undersurface of the right tentorial leaflet (images 12 and 13 on series 4), likely represent tiny incidental lipomas.

Impressions
1. Redemonstrated acute fractures of the bilateral C7 pedicles with fracture on the left extending into the articular pillar, characterized to better advantage on recent performed CT and likely without significant change. Stable jumped right C6-C7 facet joint.
2. Attenuated appearance of the posterior longitudinal ligament at C6-C7 with corresponding widening of the C6-C7 interspinous interval raises concern for ligamentous injury. Trace fluid signal just dorsal to the posterior longitudinal ligament at this level may represent a trace amount of extra-axial blood product.
3. T1 hypointensity along the anterosuperior T1 vertebral body with
corresponding T2/STIR hyperintensity, likely representing bony contusion. No other evidence of acute vertebral body fracture or height loss.
4. No abnormally elevated signal within the cervical cord to suggest cord injury.
5. Extensive signal intensity within the posterior paraspinal soft
tissues and interspinous regions most prominent at the C6-C7 level, likely reflecting interspinous ligament is injury.
6. Multilevel degenerative changes in the cervical spine with spinal
canal and foraminal stenosis. There is moderate to severe canal stenosis at the C5-C6 level related to disc and endplate spurring.