Presentation
Cyclist struck by motor vehicle. Polytrauma.
Patient Data
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.
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