Traumatic disco-ligamentous injury of the cervical spine with vertebral artery dissection
Presentation
Intoxicated driver involved in a high-speed motor vehicle accident.
Patient Data
- exaggerated cervical lordosis at C4/C5 secondary to anterolisthesis of the C5 vertebral body
- associated widening of the anterior intervertebral disc space at C4/C5
- widening of the right facet joint at C4/C5
- right transverse process fracture of C4 without the involvement of the transverse foramen
- bilateral C5 transverse process fractures with extension into the transverse foramen
- fracture of the left anterior scalene tubercle of the right C6 transverse foramen.
- significant prevertebral hematoma indicating a ligament injury
- anterior epidural hematoma extending from the intervertebral disc space at C4/C5 along the posterior aspect of the C5 vertebral body
Non- opacification of the left vertebral artery is seen in the region of the C4/5 injury with irregular opacification of the more distal V2, V3 and 4 (intradural) segments consistent with dissection.
Complete disruption of the C4/5 and anterior and posterior longitudinal ligaments. This is associated with extensive thickening of the prevertebral soft tissues. A small epidural hematoma extends from the C4/5 level, down to C6, without evidence of cord compression. Widening of the C4/5 facet joints with associated interspinous ligament damage, not only at this level but also at the level above and below. A flow void in the left vertebral artery is not visible, instead a high signal is seen along its length (including V4) consistent with dissection and thrombosis.
Case Discussion
Multiples cervical injuries are demonstrated by this case, including disco-ligamentous injury at C4/5 with a widening of the associated facet joints (consistent with an unstable three-column injury) and left vertebral artery dissection/occlusion. These findings are consistent with a severe hyper-flexion mechanism of injury to the cervical spine.
Case courtesy of Associate Professor Pramit Phal