C6 compression fracture with posterior spinal fractures and cord contusion
Presentation
Pedestrian struck in MVC. Neck pain. Significant immediate motor deficit with left arm flexion and complete left leg paralysis. Weak right limbs. Right leg pain sensation lost and midthoracic sensory level. Fecal incontinence.
Patient Data
Immobilized in trauma collar.
Normal atlanto-occipital articulations.
Multilevel cervical spine fracture:
C3: spinous process fracture
C4: spinous process fracture
C5: bilateral laminar fractures; slightly displaced into the spinal canal on the right
C6: three column injury; through middle of vertebral body with loss of body height and involving both laminae (undisplaced) and the articular processes on the left
C7 and the C7/T1 articulation are normal.
No appreciable epidural abnormality on CT. There is contusion in the soft tissues around the spinous process fractures and almost certainly intraspinous ligament damage. Vertebral body alignment is normal, and apart from the undisplaced fracture at left C6 there is no violation or widening of the facet joints.
Head and whole spine also imaged with no other traumatic finding.
Impression:
Multilevel cervical fractures and likely ligamentous injury.
Three column injury at C6.
High STIR signal in the C6 vertebra with loss of vertebral body height in keeping with the known compression fracture with sagittal fracture cleft. There is minor anterior narrowing of the spinal canal at this level but canal remains capacious with no cord compression. The cord is expanded at this level with T2 hyperintensity extending craniocaudally over 19 mm.
The ligamentum flavum is discontinuous at the C5/6 level, and at C6 the posterior longitudinal ligament is also difficult to define.
Bony edema corresponding to C3 - C5 posterior element fractures. There is extensive posterior paraspinal muscle edema. There is further superior endplate marrow edema at C7 and T1 although no height loss is demonstrated on CT.
Extensive edema of the interspinous ligaments and paraspinal muscles at C5 to T1. Normal facet joint alignment bilaterally.
Normal intervertebral discs. No epidural hemorrhage.
Opinion:
C6 compression/sagittal fracture involving posterior elements. PLL and ligamentum flavum discontinuity.
Posterior element fractures C3-C5.
Cord contusion at C6 level.
The patient was managed with halo immobilization. Persisting incomplete tetraparesis.
One mth FU following halo...
One mth FU following halo immobilization.
Reduced height of C6 vertebral body, with healed posterior elements.
Myelomalacia of the cord at C6, predominantly left and dorsal cord affected.
Case Discussion
Access to urgent MRI for cervical spine injuries with neurological deficits is an essential part of spinal care. This case demonstrated contusions at the C6 fracture level (with associated posterior element fractures at other levels), with maturation to myelomalacia on follow up imaging.