Wk 5, Case 50 - Review

EXAMINATION: CT cervical spine

INDICATION: Trauma

COMPARISON: None available.

TECHNIQUE: CT images of the cervical spine were performed without contrast. Multiplanar reconstructions were obtained.

FINDINGS:

Mildly displaced transversely oriented fracture through both pedicles of the C7 vertebra with involvement of the left transverse foramen. Jumped facet at C6-C7 on the right with perched facet on the left. Mild widening of the interspinous distance at C6-C7. No traumatic spondylolisthesis. Atlanto-occipital and atlanto-dental articulations are preserved.

7 cervical-type vertebral bodies. Straightening of the normal cervical lordosis. Moderate to severe multilevel degenerative disc disease, greatest at the C5-C6 and C6-C7 levels. Multilevel uncovertebral and facet joint arthrosis results in bilateral foraminal narrowing, up to severe at C5-C6 on the left.

Heterogeneous opacities of both lung apices, possibly representing aspiration and/or early contusion. Partially imaged intracranial structures are unremarkable. Mild craniocervical vascular calcifications.

IMPRESSION:

Unstable fracture of the C7 vertebra involving both pedicles and left transverse foramen. Jumped facet on the right and perched facet on the left at C6-C7. MRI is recommended for further characterization.

EXAMINATION: MRI cervical spine without contrast.

CLINICAL HISTORY: Trauma

COMPARISON: Same day CT C-spine

TECHNIQUE: Multiplanar multisequence MRI images of the cervical spine performed without administration of intravenous contrast.

FINDINGS:

Redemonstration of a mildly displaced fracture involving the posterior elements of C7 extending to the transverse foramen on the left. Additional areas of high signal intensity involving the inferior aspect of the C7 vertebral body and superior aspect of the T1 vertebral body, likely representing nondisplaced fractures that were previously occult to CT.

Interspinous ligamentous injury at C6-C7 as evidenced by widening of the interspinous distance, discontinuity of the spinolaminar line, and edema within the posterior soft tissues. 1-2 mm posterior epidural hematoma extending from C4-C6 (Key Image 1).

No additional areas of ligamentous injury. Normal cord signal in the cervical spine. Multilevel degenerative disc disease throughout the cervical spine resulting in up to moderate spinal stenosis, greatest at C5-C6.

Bilateral vertebral arteries demonstrate normal flow voids. Partially imaged intracranial structures are unremarkable.

IMPRESSION:

1. Redemonstration of fracture involving the posterior elements of the C7 vertebra with additional nondisplaced fractures of the C7 and T1 vertebral bodies. Findings represent an unstable three-column injury.

2. Interspinous ligamentous injury at C6-C7 with widening of the interspinous distance and discontinuity of the spinolaminar line.

3. Posterior epidural hematoma measuring 1-2 mm extending from C4-C6.