Upper Cervical and Thoracic Spine Trauma

Question 1

What are the indirect signs of cervical spine trauma?

What are the direct signs?

Answer 1

• widened retropharyngeal space (7mm at C2, 20mm at C6)
• displaced pre-vertebral fat strip (secondary to hemmorage/ edema)–> may deviate trachea
• Loss of lordosis
• Torticollis
• widened interspinous space (ligament damage/ rupture)
• vert rotation/ bowtie sign)
• increased ADI (3mm adults, 5mm children) due to Transverse ligament disruption.
• widened narrowed disc space

Direct signs

• disruption of georges line/ SPinolaminar line (C1 sits few mm forward normal)
• fracture

Question 2

Name the possible Atlas injuries?

Answer 2

1. isolated posterior arch fracture (ass. with hyperextension injuries)
2. Jeffersons fracture (burst fx from axial compression- 4 fxs)–> neurological complications uncommon. Will see lateral displacement of lateral masses.
3. Atlantoaxial dislocation- transverse ligament rupture common, dens usually fractures first. -see increased ADI

Question 3

Axis injuries?

Answer 3

1. Os terminale
2. Os odontoideum
   (normal variants)
3. Odontoid fractures:
   a) Type 1- tip of dens- stable
   b) type 2- base of dens- UNSTABLE- m.c to result in non-union fx
   c) Fx through C2 body, stable injury, usually heals without complication
4. Hangmans frature- fx through pedicles of C2, due to hyperextension injury.

Question 4

What are the Lower C spine injuries?
flexion injuries?
What would each MOI be?

Answer 4

Flexion Injuries: often unusable due to posterior ligament damage. Ass. injuries are often compression or burst injuries.

1. Compression fracture
2. Burst fracture
3. teardrop (unstable) or corner (stable) fracture -usually inferior corner, shearing force
4. Unilateral facet dislocation- bow-ties sign, due to flexion with rotation
5. Bilateral Facet dislocation
   - body above displaces anterior at least 1/2 the depth of body below -same as for above.

Question 5

Lower C spine Extension Injuries?

General info?

Answer 5

• may be unstable
• results in anterior ligament and disc damage.
• buckling of the ligamentum flavum may cause posterior cord trauma
• assosiated injuries include teardrop or corner fractures, and posterior arch fractures.

Question 6

What is fx of C7 SP called? What MOI?

Answer 6

Clayshovelers

• C7 m.c level
• stable
• due to avulsion injury or direct blow
• SP moves inferior= double spinous sign on APLC