Ligament injury and cord edema in cervical spine trauma

Case contributed by Vikas Shah


Hit by car whilst riding bicycle. Neck, chest and abdominal pain.

Patient Data

Age: 40 years
Gender: Male

CT of cervical spine


Undisplaced fracture of spinous process of C3 and displaced fractures of spinous processes of C7 and T1. Avulsion fracture of antero-superior osteophyte of C5. Small prevertrebral hematoma anterior to C2-C3 disc raises suspicion of longitudinal ligamentous injury. 

The remainder of the whole body trauma CT showed no other skeletal injury, and no pulmonary, vascular or solid organ injury.

He developed neurological symptoms so an MRI of the spine was requested.

MRI confirms anterior paravertebral hematoma at C2 to C4 level, with disruption of the anterior longitudinal ligament at C3-C4 level. At this level, there is also abnormal high signal and mild expansion of the cord. No cord or epidural hematoma. Edema in the paraspinal musculature and fractures of spinous processes of C7 and T1 as seen on the CT. High signal also present in C4-C5 disc adjacent to the corner osteophyte fracture seen on CT.

Case Discussion

This case highlights the importance of identifying signs pointing to ligamentous injury on cervical spine CT. The corner osteophyte fracture, prevertebral hematoma, disruption of anterior longitudinal ligament and cord edema indicate a severe hyper-extension injury. A conservative management pathway was followed with an unremarkable recovery,

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