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so in this lecture will be discussing
spinal trauma when a patient comes in
with a traumatic injury to the spine
imaging can play a key role because it
can help you exclude an abnormality that
can lead to a long-term complication in
the patient such as paralysis so when a
patient comes in with a cervical spine
trauma if there's any kind of suspicion
of a spinal fracture the patient's neck
should not be moved because an unstable
fracture can compromise spinal cord
integrity so the first thing that's done
is a trauma protocol which involves a
cross-table lateral radiograph of the
neck and this ensures that there is no
fracture or subluxation of the cervical
spine prior to obtaining further imaging
which may involve manipulation of the
patient's neck common mechanisms of
spine trauma include a flexion injury an
extension injury a rotational injury or
a shearing abnormality so these are some
common spinal fractures the most common
fracture of the spine is a compression
fracture we can also have what's called
a burst fracture a burst fracture is
caused by an axial loading injury in
which the disc above is pushed into the
vertebral body below this can result in
a comminuted fracture of the vertebral
body and it's often associated with Rett
repulsion of bony fragments into the
spinal canal which results in an
unstable fracture that can cause
neurologic deficits so this is an
example of a radiograph and a CT scan
that demonstrates the burst fracture so
you can see that there's a comminuted
compression fracture of the vertebral
body and there's there's displacement of
bony fragments posteriorly into the
spinal canal so if you look at the
posterior vertebral line here when you
get to the level of the fracture it's
displaced posteriorly indicating
posterior retropropulsion of fragments
on the CT scan you can see that there's
a fracture of the vertebral body and the
fragment is pushed posteriorly into the
spinal canal there's what's called a
chance fracture and a chance fracture is
also called a seatbelt fracture and it's
usually caused by a lap belt in a motor
vehicle accident this is a type of
flexion distraction injury and you have
fractured through the vertebral body the
and the spinous process this can
actually be associated with an increased
interest - distance and you have
separation of the facet joints so this
is also a very unstable fracture and it
can be associated with neurological
deficits often this is associated with
abdominal visceral injuries as well
because of the lap belt so here we have
two CT scans sagittal images which
demonstrate a fracture through the
vertebral body and the spinous process
so this is an example of a chance
fracture often these are associated with
an epidural hematoma and possibly a cord
contusion as well so Jefferson fractures
are axial loading injuries you have
offset of the lateral masses of c1 with
respect to the lateral margins of c2
when you do an open-mouth radiograph of
the cervical spine there are also
fractures of the anterior and posterior
arches of the c1 ring and this is best
seen on a CT scan usually these are not
associated with the neurological
deficits so let's take a look at this
example of a Jefferson fracture this is
what's called an open mouth view and it
demonstrates lateral displacement of the
lateral masses in a Jefferson fracture
so here we have lateral displacement of
the two masses laterally when you
compare it with the lateral margins of
the C two vertebral body you can see the
prominence of the lateral displacement
here when you compare it with a normal
film here you can see that this is well
aligned so the lateral margins of c1 and
the lateral margin of c2 is actually
well aligned well with the Jefferson
fracture it's not and you see a step off
on both sides on a CT you can see a
fracture involving the anterior and
posterior arch of c1 so here we have a
fracture involving the anterior arch and
then here we have a fracture involving
the posterior arch so when you're taking
a look at a CT and you see a fracture of
either the anterior or posterior arch
you want to take a look for a second
fracture because this is a ring usually
rings fracture in two different places
not just one so if you see one you may
be missing a subtle second fracture a
hangman's fracture is actually a
hyperextension compression injury so
this can occur in patients such as the
unrestrained passenger who
hits their forehead on a windshield in a
motor vehicle accident this is not truly
associated with the judicial hanging
which actually ends up causing
hyperextension resulting in distraction
of c-2 and c-3 and distraction of the
cord imaging findings include a fracture
of the posterior elements of c2 and the
posterior aspect of c2 is actually
separated from the anterior aspect of c2
so this results in anterior displacement
of c2 on c3 this is actually not usually
associated with neurological deficits so
this is an example of a hangman's
fracture this is a lateral cervical
radiograph which demonstrates posterior
displacement of the spinal laminar line
so you can see here the line drawn with
a posterior displacement right here and
then again it moves anterior here the
line should actually remain symmetric
all the way up and down
you also have anterior displacement of
the c2 vertebral body and you have
fracture of the posterior elements of c2
so we've gone over several of the common
spinal fractures that you may encounter
again these are very important to
recognize because they may have chronic
neurological deficits associated with
them
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you