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Non-contiguous spinal injury in cervical spinal trauma: evaluation with cervical spine MRI.

Choi SJ, Shin MJ, Kim SM, Bae SJ - Korean J Radiol (2004 Oct-Dec)

Bottom Line: Ligament injury in these regions was found in three cases.Traumatic disc herniation and spinal cord injury in these regions were shown in one and two cases, respectively.However, there was no statistical significance (p > 0.05).

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Songpa-gu, Seoul, Korea.

ABSTRACT

Objective: We wished to evaluate the incidence of non-contiguous spinal injury in the cervicothoracic junction (CTJ) or the upper thoracic spines on cervical spinal MR images in the patients with cervical spinal injuries.

Materials and methods: Seventy-five cervical spine MR imagings for acute cervical spinal injury were retrospectively reviewed (58 men and 17 women, mean age: 35.3, range: 18 81 years). They were divided into three groups based on the mechanism of injury; axial compression, hyperflexion or hyperextension injury, according to the findings on the MR and CT images. On cervical spine MR images, we evaluated the presence of non-contiguous spinal injury in the CTJ or upper thoracic spine with regard to the presence of marrow contusion or fracture, ligament injury, traumatic disc herniation and spinal cord injury.

Results: Twenty-one cases (28%) showed CTJ or upper thoracic spinal injuries (C7-T5) on cervical spinal MR images that were separated from the cervical spinal injuries. Seven of 21 cases revealed overt fractures in the CTJs or upper thoracic spines. Ligament injury in these regions was found in three cases. Traumatic disc herniation and spinal cord injury in these regions were shown in one and two cases, respectively. The incidence of the non-contiguous spinal injuries in CTJ or upper thoracic spines was higher in the axial compression injury group (35.3%) than in the hyperflexion injury group (26.9%) or the hyperextension (25%) injury group. However, there was no statistical significance (p > 0.05).

Conclusion: Cervical spinal MR revealed non-contiguous CTJ or upper thoracic spinal injuries in 28% of the patients with cervical spinal injury. The mechanism of cervical spinal injury did not significantly affect the incidence of the noncontiguous CTJ or upper thoracic spinal injury.

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T1- (A) and T2- (B) weighted sagittal MR images in a patient with type III dens fracture (not shown).A. T1-weighted MR image shows compression fracture of C7 (large arrow) and linear prevertebral hemorrhage (small arrows) that resulted from C2 fracture.B. Note the traumatic disc herniation (open arrow) and a focal compressive myelopathy (arrowhead) at the disc level of C7-T1.
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Figure 3: T1- (A) and T2- (B) weighted sagittal MR images in a patient with type III dens fracture (not shown).A. T1-weighted MR image shows compression fracture of C7 (large arrow) and linear prevertebral hemorrhage (small arrows) that resulted from C2 fracture.B. Note the traumatic disc herniation (open arrow) and a focal compressive myelopathy (arrowhead) at the disc level of C7-T1.

Mentions: For the 17 axial compression injuries, six (35.3%) had non-contiguous CTJ or upper thoracic spinal injuries, and marrow contusions and overt fractures were found in three of them (17.6%). These injuries were shown in two of the Jefferson fractures (Fig. 1) and in four of the vertical compression injuries of the lower cervical spines. Overt fractures in the CTJ or upper thoracic spines were associated with one Jefferson fracture and two vertical compression injuries of the lower cervical spines. In the last two cases, non-contiguous ligament injuries (11.8%) were also found at the non-contiguously injured sites (Fig. 2). Non-contiguous spinal cord injury (5.9%) was also found in one of those cases. In the 26 hyperflexion injuries, seven of them (26.9%) had non-contiguous CTJ injury or upper thoracic spinal injuries; there were marrow contusions in five (19.2%) and overt fractures in two (7.7%). The non-contigous injuries were shown in one of the type III dens fractures, three of the compressive flexion injuries, and three of the distractive flexion injuries of the cervical spines. Overt fractures in the CTJ or upper thoracic spines were associated with one type III dens fracture and with one of the distractive flexion injuries of the lower cervical spine. In the case of the type III dens fracture, disc herniation with posterior longitudinal ligament tearing and focal spinal cord injury were also found in the CTJ as well as a non-contiguous wedge compression fracture (Fig. 3). Therefore, the incidence of the non-contiguous disc herniation, ligament or spinal cord injury in the hyperflexion injuries was 3.8%, respectivery. In the 32 hyperextension injuries, eight of them (25%) had non-contiguous CTJ or upper thoracic spinal injuries; six (18.8%) had marrow contusions and two (6.3%) had overt fractures. The above injuries were shown in one of the hangman's fractures, in four of the distractive extension injuries, in two of compressive extension injuries, and in one of the compressive and distractive extension injuries of the lower cervical spines. Overt fractures in the CTJ or upper thoracic spine were associated with two distractive extension injuries of the lower cervical spines. In one case of distractive extension injury of lower cervical spine, non-contiguous ligament injury (3.1%) was found in the CTJ (Fig. 4).


Non-contiguous spinal injury in cervical spinal trauma: evaluation with cervical spine MRI.

Choi SJ, Shin MJ, Kim SM, Bae SJ - Korean J Radiol (2004 Oct-Dec)

T1- (A) and T2- (B) weighted sagittal MR images in a patient with type III dens fracture (not shown).A. T1-weighted MR image shows compression fracture of C7 (large arrow) and linear prevertebral hemorrhage (small arrows) that resulted from C2 fracture.B. Note the traumatic disc herniation (open arrow) and a focal compressive myelopathy (arrowhead) at the disc level of C7-T1.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2698165&req=5

Figure 3: T1- (A) and T2- (B) weighted sagittal MR images in a patient with type III dens fracture (not shown).A. T1-weighted MR image shows compression fracture of C7 (large arrow) and linear prevertebral hemorrhage (small arrows) that resulted from C2 fracture.B. Note the traumatic disc herniation (open arrow) and a focal compressive myelopathy (arrowhead) at the disc level of C7-T1.
Mentions: For the 17 axial compression injuries, six (35.3%) had non-contiguous CTJ or upper thoracic spinal injuries, and marrow contusions and overt fractures were found in three of them (17.6%). These injuries were shown in two of the Jefferson fractures (Fig. 1) and in four of the vertical compression injuries of the lower cervical spines. Overt fractures in the CTJ or upper thoracic spines were associated with one Jefferson fracture and two vertical compression injuries of the lower cervical spines. In the last two cases, non-contiguous ligament injuries (11.8%) were also found at the non-contiguously injured sites (Fig. 2). Non-contiguous spinal cord injury (5.9%) was also found in one of those cases. In the 26 hyperflexion injuries, seven of them (26.9%) had non-contiguous CTJ injury or upper thoracic spinal injuries; there were marrow contusions in five (19.2%) and overt fractures in two (7.7%). The non-contigous injuries were shown in one of the type III dens fractures, three of the compressive flexion injuries, and three of the distractive flexion injuries of the cervical spines. Overt fractures in the CTJ or upper thoracic spines were associated with one type III dens fracture and with one of the distractive flexion injuries of the lower cervical spine. In the case of the type III dens fracture, disc herniation with posterior longitudinal ligament tearing and focal spinal cord injury were also found in the CTJ as well as a non-contiguous wedge compression fracture (Fig. 3). Therefore, the incidence of the non-contiguous disc herniation, ligament or spinal cord injury in the hyperflexion injuries was 3.8%, respectivery. In the 32 hyperextension injuries, eight of them (25%) had non-contiguous CTJ or upper thoracic spinal injuries; six (18.8%) had marrow contusions and two (6.3%) had overt fractures. The above injuries were shown in one of the hangman's fractures, in four of the distractive extension injuries, in two of compressive extension injuries, and in one of the compressive and distractive extension injuries of the lower cervical spines. Overt fractures in the CTJ or upper thoracic spine were associated with two distractive extension injuries of the lower cervical spines. In one case of distractive extension injury of lower cervical spine, non-contiguous ligament injury (3.1%) was found in the CTJ (Fig. 4).

Bottom Line: Ligament injury in these regions was found in three cases.Traumatic disc herniation and spinal cord injury in these regions were shown in one and two cases, respectively.However, there was no statistical significance (p > 0.05).

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Songpa-gu, Seoul, Korea.

ABSTRACT

Objective: We wished to evaluate the incidence of non-contiguous spinal injury in the cervicothoracic junction (CTJ) or the upper thoracic spines on cervical spinal MR images in the patients with cervical spinal injuries.

Materials and methods: Seventy-five cervical spine MR imagings for acute cervical spinal injury were retrospectively reviewed (58 men and 17 women, mean age: 35.3, range: 18 81 years). They were divided into three groups based on the mechanism of injury; axial compression, hyperflexion or hyperextension injury, according to the findings on the MR and CT images. On cervical spine MR images, we evaluated the presence of non-contiguous spinal injury in the CTJ or upper thoracic spine with regard to the presence of marrow contusion or fracture, ligament injury, traumatic disc herniation and spinal cord injury.

Results: Twenty-one cases (28%) showed CTJ or upper thoracic spinal injuries (C7-T5) on cervical spinal MR images that were separated from the cervical spinal injuries. Seven of 21 cases revealed overt fractures in the CTJs or upper thoracic spines. Ligament injury in these regions was found in three cases. Traumatic disc herniation and spinal cord injury in these regions were shown in one and two cases, respectively. The incidence of the non-contiguous spinal injuries in CTJ or upper thoracic spines was higher in the axial compression injury group (35.3%) than in the hyperflexion injury group (26.9%) or the hyperextension (25%) injury group. However, there was no statistical significance (p > 0.05).

Conclusion: Cervical spinal MR revealed non-contiguous CTJ or upper thoracic spinal injuries in 28% of the patients with cervical spinal injury. The mechanism of cervical spinal injury did not significantly affect the incidence of the noncontiguous CTJ or upper thoracic spinal injury.

Show MeSH
Related in: MedlinePlus