Presentation
Adult patient with cervical spine trauma (MVA).
CT scan of the cervical spine demonstrates unremarkable alignment and no convincing fracture. There is a suggestion of increased pre-vertebral swelling/fluid.
MRI demonstrates extensive soft tissue high signal in the interspinous region (best seen on STIR) as well as high signal anteriorly in the C5/6 disc, with interruption of the anterior annular fibers consistent with disruption.
The right vertebral artery demonstrates high signal on T2 and intermediate signal on T1 sequences, consistent with vertebral artery thrombosis, presumably due to traumatic vertebral artery dissection.
Case Discussion
Signs of disco-ligamentous injury can be subtle on CT and careful examination for focal widening of discs and facets and the presence of soft tissue injury is necessary. In the correct clinical setting, MRI is necessary even when CT is apparently normal.
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