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.
