Traumatic disco-ligamentous injury of the cervical spine with vertebral artery dissection

Case contributed by Dr Rajalakshmi Ramesh


Intoxicated driver of vehicle involved in high speed crash

Patient Data

Age: 53
Gender: Male

Exaggerated cervical lordosis at C4/C5 secondary to anterolisthesis of the C5 vertebral body. This is associated with widening of the anterior intervertebral disc space at C4/C5. There is widening of the right facet joint at C4/C5. Right transverse process fracture of C4 without 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 consistent with 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 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 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

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Case information

rID: 33682
Published: 20th Jan 2015
Last edited: 14th Aug 2019
System: Spine
Inclusion in quiz mode: Included

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