The mri-findings are: Soft tissue swelling anteriorly disruption of the disc Non-hemorrhagic cord injury continue with the axial image. Notice on the axial image that the cord injury is located in the grey matter, which is more sensitive to damage. Closed reduction under fluoroscopy. Scroll through the images. reduction under fluoroscopy In order to regain normal alignment, progressive weights are used to lengthen the spine until reduction is achieved. Scroll through the images on the left.
Because of its extensive soft tissue damage and dislocated facet bad joints, bid is unstable and is associated with a high incidence of cord damage. Bilateral interfacetal dislocation First study the images on the left. The findings are: Bilateral interfacetal dislocation. 50 anteroposition C5C6 as a result of the dislocation. In unilateral dislocation the anteroposition is usually only. Widened space between spinous processes C5 and C6 due to ligament rupture. On the left ct-images of the same patient, which confirm the bilateral dislocation. Near one of the facets there is a small fleck of bone, but there is no major fracture, so this is basically just a hyperflexion soft tissue injury. Double inverted hamburger sign in bilateral facetal dislocation On the axial images the inverted hamburger sign is seen on both sides. Bilateral interfacetal dislocation (2) On the left you can scroll through the 3D-reconstructions. Bilateral interfacetal dislocation (3) First study the mr-images for additional findings.
Continue with the mr-images Unilateral interfacetal dislocation First study the mr-images. The mri-findings are: Spinal cord lesion, which can be described as contusion, edema or non-hemorrhagic spinal cord injury. Rupture of the spinous ligaments. Rupture of the ligamentum flavum. Rupture of the disc with migration of disc material on the posterior side of C4 and even on the anterior side. The disc space is always daddy disrupted in this kind of injury due to the extreme rotation. Bilateral Interfacetal Dislocation Bilateral interfacetal dislocation (BID) is the result of extreme hyperflection. There is anterior dislocation of the articular masses with disruption of the posterior ligament complex, posterior longitudinal ligament, the disc and usually also the anterior longitudinal ligament. When the dislocation is complete, the dislocated vertebra is anteriorly displaced one-half of the ap diameter of the vertebral body.
Mri plays an important role in the diagnosis in order to see if there is disc extrusion leading to cord compression. On the left images of a 20 year old male who had a rollover motor vehicle accident. The radiographic findings are: Hyperflexion at the level of C4C5 with widening of the interspinous space subluxation at the level of C4C5 with about 25 translation (i.e. Anteroposition of 25 of the ap diameter of the vertebral body) Malalignment of the spinous processes as seen on the ap-view, which with can only be produced by a rotatory injury. The involved spinous process points to the involved side due to the rotation the spinous processes of C4 and C5 seem shorter on the lateral view The ct confirms the unilateral dislocation. The contralateral write facetjoint is only distracted. Inverted hamburger sign in unilateral interfacetal dislocation Unilateral interfacetal dislocation (2) On the axial view the left facet joint is normal and the configuration has similarities with the hamburger. On the right side the classic 'inverted hamburger sign' is seen.
Vertebral artery thrombosis: no flow void in the right vertebral artery The axial image shows the spinal cord injury and in addition to it there is absence of flow void in the right vertebral artery. This indicates thrombosis as a result of dissection. In conclusion we can say that this patient had no fracture, but a severe hyperflexion sprain with acute disc herniation, non-hemorrhagic spinal cord injury and vertebral thrombosis. Right vertebral artery thrombosis The mra confirms the occlusion of the right vertebral artery. Unilateral interfacet dislocation Unilateral interfacet dislocation is due to a hyperflexion injury with rotation. The superior facet on one side slides over the inferior facet and becomes locked. This results in an anterior subluxation of the upper vertebral body of about 25 of the ap diameter of the body. Simple unilateral facet dislocation is a stable injury. 30 of patients have an associated neurologic defect.
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She subsequently had a second fall the following morning, where after she had complete loss of motor and sensation. On physical examination there was lower extremity paraparesis with some upper extremity weakness on the right. Central cord injury was proposed initially. The radiographs report were normal. The findings are: Small bone fragmets comming off the superior and inferior facets Widened interspinous space at C5-6 Soft tissue swelling at this level posteriorly subtle narrowing of the disc space at the C5-6-level. These ct-findings are very subtle and do not seem to match the neurological problem. In such a case mri is the next step.
First we show you a coronal and axial ct with also a soft tissue window-setting. There is high density material at the back of the disc space, which is very suggestive for a traumatic disc herniation. A epidural hematoma should be in the differential, but this finding was limited to just the area of the disc space, unlike a hematoma. Continue with the. Hyperflexion sprain with spinal cord injury hyperflexion sprain (3) The mri explains the neurological status of this patient. The mr-findings are: severe soft tissue injury of the posterior paraspinal structures, especially at the C5-6 level, where the interspinous ligament and the ligamentum flavum is ruptured Disruption of the C5-6 disc with migration behind C5 Large amount of spinal cord edema continue with the.
Brown-Sequard Syndrome after stab wound with screwdriver On the left images of spinal cord injury after a stab wound with a screwdriver. This resulted in a brown-Sequard syndrome due to hemisection of the spinal cord. Hyperflexion injuries Hyperflexion sprain without fracture hyperflexion Sprain Hyperflexion sprain injuries are injuries to the soft tissues of the spine without fracture. On x-rays this can only be suspected when there is angulation or translation mr will demonstrate subtle injuries to the soft tissues. On the left images of a patient who has been in a car accident and complained of neck pain. The x-rays were normal and there were no neurological symptoms.
First study the images on the left. The findings are: Edema in the posterior soft tissues indicating a hyperflexion injury Edema in the vertebrae of the lower C-spine and upper T-spine indicating bone bruise as a result of axial loading. In this patient we can conclude that there was mild hyperflexion strain and we do not know if a special treatment is required, since these were isolated mr-findings without evidence of fracture or abnormal positioning. There is controversy regarding the meaning of soft tissue abnormalities detected only on mri. Signal changes do not necessarily equate with structural failure. These findings still require better validation. In trauma centres up to 25 of all patients with neck injury have signal abnormalities on mr and the significance is indeterminate. Hyperflexion sprain Hyperflexion sprain (2) On the left images of a 44 year old female, who sustained a fall on the ice.
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Upper extremity deficit is book greater than lower extremity deficit, because the lower extremity corticospinal tracts are located lateral in the cord. Anterior cord syndrome seen in flexion injuries. Burst fracture, flexion tear drop fracture and herniated disk. Presents with immediate paralysis, because the corticospinal tracts are located in the anterior aspect of the spinal cord. Brown-Sequard syndrome Ipsilateral motor weakness and contralateral sensory deficit due to hemisection of the spinal cord. Brown-Sequard syndrome may result from rotational injury such as fracture-dislocation or from penetrating trauma such as stab wound. Posterior cord syndrome Uncommon syndrome due to extension injury. Loss of positioning sense due to disruption of dorsal columns. Complete spinal cord injury total absence of sensation and motor function caudal to the level of injury.
There is a for strong correlation between the length of the spinal cord edema and the clinical outcome. The most important factor however is whether there is hemorrhage, since hemorrhagic spinal cord injury has an extremely poor outcome. The chart on the left is showing the motor recovery rate for patients with edema alone (in blue) versus edema plus cord hemorrhage (in red). The motor recovery rate is for the legs only. Central spinal cord injury in a patient with a hyperextension injury and preexisting spondylosis and stenosis. Spinal cord syndromes (2 central cord syndrome most common incomplete cord syndrome. Frequently found in elderly with underlying spondylosis or younger people with severe extension injury (figure).
Extension, odontoid fracture type ii, hangman's fracture, extension teardrop fracture. Vertical compression, burst fracture,. Jefferson fracture, non-hemorrhagic and hemorrhagic spinal cord injury. Spinal cord injury, there are two types of injury to the spinal cord: Non-hemorrhagic with only high signal on mr due to edema. Hemorrhagic with areas of low signal intensity within the area of edema. Effect of spinal cord hemorrhage on motor recovery of the legs at 12 months.
Unstable wedge fracture is an unstable flexion injury due to damage to both the anterior column (anterior wedge fracture) as the posterior column (interspinous ligament). Unilateral interfacet remote dislocation is due to both flexion and rotation. Bilateral interfacet dislocation is the result of extreme flection. Bid is unstable and is associated with a high incidence of cord damage. Flexion teardrop farcture is the result of extreme flection with axial loading. It is unstable and is associated with a high incidence of cord damage. Anterior atlantoaxial dislocation, hyperextension injuries. Extension injuries, hangman's fracture, traumatic spondylolisthesis. Extension teardrop fracture, hyperextension in preexisting spondylosis 'Open mouth fracture'.
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Introduction, hyperflexion injuriesClick on the image to get a larger view. Flexion injuries, the most common fracture mechanism in cervical injuries is hyperflexion. Anterior subluxation occurs when the posterior ligaments rupture. Since the anterior and middle columns remain intact, this fracture is stable. Simple wedge fracture is the result of a pure flexion injury. The posterior ligaments remain intact. Anterior wedging of 3mm or more suggests fracture. Increased literature concavity along with increased density due to bony impaction. Usualy involves the upper endplate.