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12b - Answer: Fall from a 10 feet height with Calcaneal fracture

David Yousem MBA, MD
David M Yousem, MBA, MD
Professor of Radiology, Vice Chairman and Associate Dean
Includes DICOM files

Learn more about this case by reading the case report below. Additional instruction is provided in the Case Summary section of the course.

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Case Report

HISTORY: Fall from 10 feet. Calcaneal fracture. 

CT cervical, thoracic, and lumbar spine without contrast. 

EXAM: CT images of the cervical, thoracic, and lumbar spine without intravenous contrast, including sagittal and coronal reconstructions. 

COMPARISON: None. 

FINDINGS: 

Cervical spine: 

There is moderate to marked loss of intervertebral disc height at C5-C6 and C6-C7, with endplate erosive changes. There is no evidence of acute fracture with in the cervical spine. The vertebral body heights are otherwise preserved. The facet joints are aligned bilaterally. No evidence of prevertebral soft tissue swelling. 

C2-C3: Moderate to marked left and mild right facet degenerative changes and mild uncovertebral hypertrophy, resulting in severe left neural foraminal narrowing. Mild bulging disc without significant narrowing of the spinal canal. 

C3-C4: Moderate to marked hypertrophic facet degenerative changes bilaterally resulting in marked left and moderate to marked right neural foraminal narrowing. There is a central disc protrusion indenting the ventral thecal sac, without significant narrowing of the spinal canal. 

C4-C5: Moderate to marked left facet degenerative changes and mild uncovertebral hypertrophy. There is a central disc protrusion indenting the ventral thecal sac, without significant narrowing of the spinal canal. The neural foramina are patent. 

C5-C6: Mild facet degenerative changes bilaterally and moderate uncovertebral hypertrophy. There is a probable left paracentral and subarticular disc protrusion indenting the ventral thecal sac. No significant narrowing of the spinal canal. There is moderate right greater than left neural foraminal narrowing. 

C6-C7: Mild facet degenerative changes and uncovertebral hypertrophy. Bulging disc indenting the ventral thecal sac and spinal cord, narrowing the spinal canal to approximately 8 mm in AP dimension. Moderate to marked right and mild to moderate left neural foraminal narrowing. 

C7-T1: Patent spinal canal and neural foramina. 

The visualized posterior fossa is within normal limits. The visualized soft tissues of the neck are unremarkable. Heterogeneous thyroid gland with a 4 mm nodule in the left lobe. 

Thoracic spine: 

There is a comminuted compression fracture of the T12 vertebral body with approximately 30% loss of the vertebral height. There is a sharply angulated retropulsed fragment projecting posteriorly into the spinal canal which is narrowed to 9 mm in AP dimension. There are comminuted fracture components involving the bilateral laminae and the left transverse process of T12, as well as a horizontal fracture through the spinous process of T11. 

Neural foramina are patent at all levels. Mild dependent atelectatic changes in the visualized lungs. 

Lumbar spine: 

There is chronic deformity of the anterior/inferior L1 vertebral body with Schmorl nodes. The vertebral body heights are otherwise preserved. The facet joints are anatomically aligned. There is loss of intervertebral disc height at multiple levels, most prominently at L3-L4 and L5-S1, with vacuum clefts. 

T12-L1: Patent spinal canal and neural foramina. 

L1-L2: Patent spinal canal and neural foramina. 

L2-L3: Mild bulging disc without significant narrowing of the spinal canal. There is a right subarticular disc protrusion narrowing the right lateral recess. No significant neural foraminal narrowing. 

L3-L4: Bulging disc indenting the ventral thecal sac without significant narrowing of the spinal canal. There is mild narrowing of the neural foramina bilaterally. 

L4-L5: Mild facet degenerative changes. There is a diffuse bulging disc resulting in narrowing of the spinal canal to 9 mm in AP dimension, compounded by thickened ligamenta flava. There is narrowing of the lateral recesses with the bulging disc potentially contacting the descending L5 nerve roots bilaterally. 

L5-S1: Diffuse bulging disc and weekend ligamenta flava resulting mild narrowing of the spinal canal. There is marked narrowing of the right neural foramen with apparent flattening of the exiting L5 nerve root, compounded by facet degenerative changes. Mild narrowing of the neural foramen. 

The visualized abdominal and pelvic contents are within normal limits. 

IMPRESSIONS: 

  1. Complex fracture involving the T11 and T12 vertebral bodies, involving all 3 columns. There is a comminuted compression fracture of the T12 vertebra with retropulsed fragments into the spinal canal which is narrowed as above, concerning for possible spinal cord injury. There is fracture of the posterior elements of T12 as well as the T11 spinous process. The overall configuration is consistent with a Chance type fracture/ flexion-distraction injury.
  2. Recommend further evaluation with MRI.
LESSON 4, TOPIC 6

Case Challenge: Spine MRI Cases - I-MED Study

Content reviewed: May 12, 2022