Cervical Spine Trauma
Aaron B. Welk, DC
Resident, Department of Radiology
Logan College of Chiropractic
Three Column Model
• Anterior
– ALL
– Anterior half of vertebral body, disc, and supporting soft
tissues
• Middle
– PLL
– Posterior half of vertebral body, disc, and supporting soft
tissues
• Posterior
– Posterior elements
– Facet joints
– Associated soft tissues
Three Column Model
• Disruption of only one column is generally
stable
• Disruption of 2 or 3 columns implies instability
• Flexion and extension films may highlight
instability that is not evident on neutral
lateral.
Evaluation Of Alignment
-Instability may be subtle.
-Disruption of any one of the
anatomical lines may indicate
injury.
-Evaluation of 4 lines must be
done on all lateral films.
-Anterior body line (A)
-Posterior body line (B)
-Spinolaminar line (C)
-Posterior spinous line
Flexion Injury
• Unilateral Locked Facet
– Flexion with rotation
– Most common location is C4/5 and C5/6
– Little or no body displacement
– Bow-tie Sign
• Bilateral Locked Facet
– Flexion with enough force to distract facets
– 50% anterolisthesis on lower segment
Unilateral Locked Facet
Bilateral Locked Facet
Bilateral Locked Facet
Left
Right
Bilateral Locked Facet
Sag T2 FSE
Sag STIR
Spinal Cord Contusion
• Non-Hemorrhagic bruising of spinal cord
• MRI Appearance:
– T1: Low signal intensity
– T2: High signal intensity
Spinal Cord Contusion
Spinal Cord Hemorrhage
• Hyperacute:
– T1: isointense
– T2: high signal intensity
• Acute:
– T1: Low signal intensity
– T2: Low signal intensity
• Subacute (early):
– T1: high signal intensity
– T2: low signal intensity
• Subacute (late):
– T1: high signal intensity
– T2: high signal intensity
• Chronic:
– T1: isointense
– T2: high signal intensity
Spinal Cord Hemorrhage
T1
T2
Flexion Injury
•
•
Anterior Wedge Compression
– Usually Stable unless posterior ligaments are disrupted
– Disrupted posterior elements may appear stable initially due to muscle spasm
Teardrop Burst
– Most severe injury compatible with life.
– 80% with neurologic injury
– Posterior body is displaced into neural canal
Teardrop Burst Fracture
Teardrop Burst Fracture
Teardrop Burst Fracture
Clay-Shoveler’s Fracture
• Oblique Fracture through the spinous process
of C6-T3 (C6 and C7 are most common)
• The name is derived from the common
occurrence of this fracture in Australian clay
miners.
• Usually caused by hyperflexion, although a
direct blow can also cause this injury
Clay-Shoveler’s fracture
Clay-Shoveler’s Fracture
Extension Injury
• Extension Teardrop
– Avulsion of ALL from inferior corner of vertebral body
– Usually at C2 or C3
• Hangman’s Fracture
– Fracture of the neural arch of C2 with varying degrees of
C2/3 disk involvement
– Type I- Fracture of neural arch w/o disk involvement
– Type II- >3mm displacement or 15˚ angulation at C2/3
– Type III- Anterior displacement of C2 due to unilateral or
bilateral facet dislocation.
• Pillar/Facet Fracture
– Extension injury while head is rotated
Extension Teardrop
Extension Teardrop
Hangman’s Fracture- Type I
Hangman’s Fracture- Type II
Hangman’s Fracture- Type III
Pillar Fracture
Pillar Fracture
Odontoid Fractures
• Mechanism of injury is not fully understood and
experimental attempts to recreate have been
unsuccessful.
• Injury is result of major force and usually results
from MVA or falls.
• 3 Classifications:
– Type I- Fracture of upper portion of dens (Stable)
– Type II- Fracture at base of dens at C2 body junction
(Unstable)
– Type III- Fracture into C2 body (Stable)*
Type I Odontoid Fracture
Type II Odontoid Fracture
Type III Odontoid Fracture
Jefferson’s (Burst) Fracture
• Ring fracture of C1 due to axial loading
• Lateral displacement of lateral masses
• May have little or no neurologic deficit unless
transverse ligament is ruptured
Jefferson’s Fracture
References
• Musculoskeletal Imaging: The Requisites, 3rd
ed. B.J. Manaster, David G. Disler, David A.
May, editors. St. Louis: Mosby; 2007. pp 164174
• Diagnosis of Bone and Joint Disorders. 4th ed.
Donald Resnick. Philadelphia: W.B. Saunders;
2002. pp 2958-2981
Images
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