IMPORTANT: We currently have a number of bugs related to image cropping and are actively trying to resolve them. In the meantime, we have disabled cropping. Apologies for any inconvenience. Stay informed: radiopaedia.org/chat

Spinal fracture and dislocation

Case contributed by Mahomed A. Osman
Diagnosis almost certain

Presentation

Cyclist struck by motor vehicle. Polytrauma.

Patient Data

Gender: Male

There is distraction at T1-T2 by distance of at least half of a vertebral body height. The T1 vertebral body is fractured posteriorly and inferiorly and there is a retropulsed fragment. There is air tracking up the epidural space to at least the level of C3-C4 and there is also dense epidural venous contrast. This appears continuous with the mediastinal air. A nasogastric tube and endotracheal tube are in place. An esophageal rupture is suspected.

Dissociation between the T1 and T2 vertebral bodies with presence of a small bone fragment in the right anterior spinal canal deforming and compressing the spinal cord with abnormal signal.Strong evidence of a major CSF leak with almost no CSF visible surrounding the spinal cord. Increased signal in the C1-C2 joint spaces without malalignment. This could represent injury involving those articulations without complete disruption. However, the tectorial membrane is focally disrupted posterior to the dens.

Case Discussion

Spinal fractures

How to use cases

You can use Radiopaedia cases in a variety of ways to help you learn and teach.

Creating your own cases is easy.

Updating… Please wait.

 Unable to process the form. Check for errors and try again.

 Thank you for updating your details.