Combined flexion-extension cervical spine fractures with traumatic spinal cord injury
Presentation
Motor vehicle collision. Shock with systolic pressure 65 mmHg.
Patient Data
Spinous process fractures from C4-C7, with the C7 fracture extending to the laminae and inferior articular processes.
Extension teardrop fracture of the antero-inferior T1 vertebral body. Central canal remains capacious with no facet joint dislocation. Prevertebral hematoma and gas extending into the superior mediastinum.
Right first rib fracture. Left pneumothorax.
C4-C7 spinous process fractures. Antero-inferior T1 vertebral body fracture with ALL disruption. Further ALL disruption at C6/7 and C7/T1.Disruption of ligamentum flavum at C7/T1. Nuchal ligament disruption/tear from C2-T1, T3-T5.
Cervical cord is expanded with edema and multifocal contusions from C2 to C7.
Prevertebral hematoma.
Case Discussion
Initially this patient's shock was thought to be hemorrhagic as there were pelvic fractures on the initial trauma series. CT showed no significant hemorrhage, and "spinal shock" was then suspected, which is a type of neurogenic shock occurs when there is disruption of motor, sensory, and sympathetic autonomic function.
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