0:01

I must admit that although we talk about hyperflexion

0:04

and hyperextension injuries to the cervical spine,

0:08

it's very rare that we actually get

0:10

that history from the clinicians.

0:12

What we usually just get is motor vehicle collision

0:16

or found down, or status post fall.

0:20

So, although there are these specific patterns of injury that

0:24

may be associated with the different

0:27

types of mechanisms of injury,

0:30

we really don't get to have that classification

0:34

provided to us by the clinical service.

0:37

Here is a list of the hyperextension injuries.

0:41

As you can see,

0:42

you may have a fracture of the spinous

0:44

process with a hyperextension injury.

0:47

You may have the hyperextension teardrop, a little triangular

0:51

fragment here with widening of the intervertebral space.

0:54

You may have some offset of the facet

0:57

joints even with a hyperextension

1:00

injury to the cervical spine.

1:03

One of the things that you should include in your

1:05

description of the injury is whether or not

1:09

the patient has underlying disease.

1:11

The reason for this is because sometimes the surgical

1:14

intervention or the necessity for surgical intervention will

1:18

be predicated upon whether or not the patient has a disease

1:22

process that may lead to instability of the spine.

1:25

Let me give an example.

1:26

Rheumatoid arthritis patient, for example,

1:29

will have laxity of the ligaments,

1:32

often at the C1-C2 level with atlantoaxial subluxation.

1:37

This is a patient who has diffuse

1:40

idiopathic skeletal hyperostosis, connecting

1:43

all these different vertebral bodies.

1:45

And he knows that there is a fracture here with an offset and

1:49

an absence of the continuation of that bony margin there

1:54

at the, I believe this is C6-C7 level. Ankylosing spondylosis,

2:00

another example where you may have syndesmosis or

2:04

syndesmophytes between the vertebral bodies and yet have

2:09

an injury that will fracture through the ankylosed

2:14

cervical spine, thoracic spine, or lumbar spine.

2:17

On the MRI scan that accompanies this case,

2:20

you see that there is narrowing of the AP diameter spinal canal

2:25

at the level of the injury with a small epidural abscess,

2:30

both posteriorly as well as anteriorly.

2:32

This is the dural margin, this black line.

2:35

This is the black line of the dural margin,

2:40

and this is the black line of the dural margin.

2:43

And on this case,

2:45

the patient had an epidural hematoma, both anteriorly as well

2:50

as extending posteriorly from this fracture through here.

2:55

Notice also the anterior longitudinal

2:57

ligament disruption and the fracture.

3:01

So this is a first-column disease as

3:05

well as second column disease.

3:07

And then we would probably look at that ligamentum

3:10

flavum and be concerned about the third column.

3:13

But in any case,

3:14

the MRI's value is not just in demonstrating

3:17

the ligamentous injury,

3:18

but also looking for cord injury as well as the presence

3:22

or absence of epidural hematomas.

Case 28 - Hyperextension Injury

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