Presentation
Heavy furniture fall on patient under which she assumed forced recumbent position. This trauma was followed by inability to move lower limbs
Patient Data
There is a comminuted fracture and marrow edema in the anterosuperior corner and superior endplate of L1 vertebral body. The fractured anterosuperior corner of L1 vertebral body is attached to the anterior longitudinal ligament; however, the posterosuperior corner of L1 vertebral body is retropulsion. There is epidural hemorrhage along the posterior aspect of T12 and L1 vertebral bodies having maximum AP diameter of 8mm. The retropulsion L1 vertebral body along with epidural hemorrhage is causing severe compression over spinal cord. There is a focal defect in the substance of distal-most spinal cord at T12-L1 level with ill-defined abnormal hyperintensity is noted in the substance of cord at T11-12 level and in conus medullaris at L1 level.
These described imaging appearances are most suggestive of spinal cord transection with intramedullary hemorrhage. Small pre and bilateral paravertebral hemorrhage is also present at same level. The right-sided paravertebral hemorrhage is extending into right posterior pararenal space and having maximum TR diameter of 10mm. A focal breach is suggested in interspinous ligament at T12-L1 level.
Edema is noted in soft tissues of the back. Overall these described imaging appearances are sequelae of antecedent trauma.
Case Discussion
Spinal cord transection is an extremely debilitating injury, causing disruption of white matter tracts, segmental grey matter and associated nerve roots. This leads to a total loss of functionality at the level of injury with resultant paralysis, paresthesia, bowel and bladder incontinence.
Case courtesy: Dr Jaideep Darira (FCPS, FRCR, EDIR)
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