Presentation
Rock climbing accident with axial loading through top of head. Movement at shoulders only.
Patient Data
Complex fracture-dislocation of C6. There is a multipart fracture of the left lateral process involving the transverse foramen, facet articulations and lamina, with a spinous process and right lamina fracture.
There is >100% anterior translation of C6 on C7 (it is never desirable to see two vertebral bodies on the same axial plane). The right facet is anteriorly translated, perched on the posterior vertebral cortex of C7. The left facet has a complex derangement lying perpendicular to the joint, perched on C7 and separated from C6.
The other spinal levels are normal (whole spine imaged, not included for upload).
Distorted and narrowed vertebral canal.
Anterior paraspinal hematoma but no evident epidural hematoma on CT.
Limited sequences performed with sufficient information obtained for surgical planning.
Findings as CT with complex fracture-dislocation of C6. Rupture of ALL, PLL and posterior ligamentous complex. No significant marrow edema at the fracture level or other imaged levels.
No disc material evident at anticipated C6/C7 level, with no posterior/epidural disc displacement. Low linear T2w material was suspected to be displaced disc material in the left prespinal soft tissues.
Spinal cord swelling and myelopathic signal from C3 to C7 level. Low T2w signal compatible with cord hematoma.
Case Discussion
This is a devastating high-energy traumatic spinal cord injury. Apart from the complex C6 fracture, the relative lack of signal change in adjacent vertebral bodies is an indicator of the force inflicted on the C6/C7 disc resulting in complete translocation with extensive cord injury including hematoma (a very poor prognostic indicator).
Access to urgent MRI is useful for surgical planning. As well as prognosticating cord injury, additional information regarding disc position and developing hematomas can inform surgical approach for fixation.
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