Spine and spinal cord
injuries
Spine and spinal cord injuries
mechanisms of spine injuries
• flexion injury
• extension injury
• axial loading
• rotation injury
Spine and spinal cord injuries
• flexion injury
mechanism
Cervical and thoracic spine thoracolumbar junction
Vertebral body fracture with anterior wedging
• extension injury
Cervical spine !
Fractures of posterior elements (posterior column), with
ligaments disruption subluxations and spodylolisthesis
NOTE! In this mechanism the spinal cord injury and root
compression may occur without evident osseous changes
visible on plain films
Spine and spinal cord injuries
mechanism
• axial loading
C spine – diving L-S spine – jumping
compression („burst”) fractures of vertebral bodies lateral
element (processes fractures) and articular pillar fractures
• rotation injury
Usually in combination with flexion-extension injury
Lateral mass fractures, luxations, uncovertebral dislocations
Spine and spinal cord injuries
effects
• oseous changes, fractures
• posttraumatic instabilities and spondylolistheses
• posttraumatic disc herniations
• spinal cord contusion
• spinal cord compression
• vascular spinal cord injury
Spine and spinal cord injuries
Osseous changes – most important sings
• atlantooccipital dislocation
common, but not always fatal
on lateral plain film: dens – basion distance > 12,5 mm
• most common to C1 is a bilateral vertical fracture through
the neural arch = a Jefferson fracture = a burst fracture that
involves both anterior and posterior arches
Posterior arch C1 fracture
Jefferson fracture – of
C1 anterior and posterior
arches :
The burst mechamism
causes the lateral
displacement of the
lateral parts of C1
Jefferson fracture
Odontoid – dense fracture
C2 fracture, is often combined with
luxation of C1 – may efect with
spinal cord compression; CT with
MPR and 3D reconstructions is
advisable
Flexion-extension mechanism:
avulsion fracture C5
spinous process fracture C7
C 2 on CT
C5
C7
rotation mechanism: C1- posterior arch, body of
C2 and odontoid fractures - luxation
Spine and spinal cord injuries
Osseous changes – most important sings
• Odontoid (dens) fractures
Usually at the base of dens – poorly visible on axial CT –
MPRs and 3Ds necessary!
• Hangman’s fracture bilateral transpedicle with the
separation of neural arch from the vertebral body and
spondylolisthesis, dens and ligaments are usually intact
Transverse C2 body fracture – Hangman’s
fracture - with bilateral arch-body separation
– the result is instability
C2 dens
apex
fracture
unvisible on
plain film!
C2 dens apex fracture
unvisible on axial CT!
C2 dens apex fracture
visible on MPR!
C2 dens apex fracture
Spinal canal stenosis can be evaluated
visible on 3D SSD!
Spine and spinal cord injuries
Osseous changes – most important sings
C1-C2 luxations
• in all methods: plain films, CT and MR:
• normal distance between anterior arch of C1 and dens of
C2 is 1 to 3 mm
• distances between dens and lateral masses of C1 should be
equal
• luxation – spondylolisthesis is important when larger than
3-4 mm
• NOTE ! Arches and processes fractures are common at C6, i
C7 and in L-S spine
> 3 mm
C1-C2
luxation
plain film
(Rheumatoid arthritis)
malum suboccipitale
C1-C2
luxation
MR T1w
(Rheumatoid arthritis)
malum suboccipitale
C1-C2
luxation
MR T2w
(Rheumatoid arthritis)
malum suboccipitale
Body and arches of C2 + arches
of C3, luxation (CT MPR and 3D SSD)
spondylolisthesis
Transpedical fracture with spondylolisthesis
C6-C7
Transpedical fracture with spondylolisthesis
C6-C7 (CT MPR)
Spine and spinal cord injuries
Osseous changes – most important sings
Compression („burst”) and multifragment fractures of vertebral
bodies may cause free osseuos fragments protrusion to the
spinal canal, resulting with spinal cord damage or/and
compression
• free or protruding osseous fragments are well seen on CT
especially with MPRs and 3D SSD reconstructions
• Spiral or multislice CT can be used to evaluate the spinal canal
stenosis caused by fractures or spondylolistheses and precisely
define the location of the most threatening fragments
Compression „burst” fracture (C5)
Burst fracture
L-S 3D SSD
Spine and spinal cord injuries
Posttraumatic spinal cord compression is
caused by:
·
haematoma
-
epidural
-
or inside the cord
·
disc herniation
·
spondylolisthesis or luxation
·
osseous fragments
Spine and spinal cord injuries

CT visualize
-
osseous changes
-
spinal canal stenosis
-
disc herniation
-
rarely haematoma
Spine and spinal cord injuries
·
MR visualize
-
cord oedema
-
haematoma, contusion, vascular injury
-
disc damage and herniation
- osseous changes are poorly visualized on MR use CT!
Instead MR perfectly visualizes spinal
cord displacement, compression and focal
lesions !
-
Posttraumatic cord oedema
Spine and spinal cord injuries
Spinal cord contusion
· bleeding foci within the cord grey matter
-
best visible on MR
-
on CT visible while massive
-
on CT hyperdense foci inside the cord
(60 – 70 HU)
-
on MR image is phase dependent
Spine and spinal cord injuries
Spinal cord contusion MR
# acute phase 1- 4 days – slightly hyperintense on T2w,
hypointense w T1w
# subacute phase 2-4 days up to 3 weeks – slightly
hyperintense on T2w, hyperintense on T1w
# chronic phase more than 3 weeks – strongly hyperintense on
T1 & T2w, accompanied by:
-
oedema – high signal on T2w
-
malacia – inhomogenous, high signal on T2w
# residual – glial scar and myelomalacia
Spine and spinal cord injuries
vascular spinal cord injury
- caused by compression, vasospasm or damage
of the spinal vessels
- resulting ischaemia leeds to necrosis and
myelomalacia
- Well seen on MR: hypointense on
T1w and hyperintense on T2w
Contusion, oedema, bleeding, disc herniation
Contusion, oedema, bleeding, disc herniation