Traumatic spinal cord injury: cord contusion

Case contributed by Dr Henry Knipe

Presentation

Post fall onto face while intoxicated.

Patient Data

Age: 30 years
Gender: Male
Modality: CT

Anterior wedging of the C5 vertebral body with 5mm retrolisthesis of C5 on C6 resulting in moderate spinal canal stenosis. A vertical fracture courses through the middle of the C5 vertebral body with extension into the posterior elements to include two separate fracture line involving the right lamina. The more lateral of the two extending to the level of the right facet joint. The foramina transversarium are not involved and there is associated widening of the interspinous space between C5 and C6. No other cervical fracture is identified. There is mild prevertebral tissue swelling associated with the fracture level.

On further assessment the patient had developed neurological symptoms of right C5/6 radiculopathy and C6/7/8 motor weakness.

Modality: MRI

Acute C5 vertebral body fracture with 4 mm of retropulsion into the central canal, which is moderately narrowed. Bone marrow oedema extends into the right C5 lamina consistent with the fracture shown on CT. Contact with the right hemicord at this level with high T2 signal and focal central blooming on GRE.

High STIR signal is seen in the left superior C6 vertebral body consistent with contusion.

Intervertebral disc space height and signal is preserved. Anterior longitudinal and posterior longitudinal ligaments are intact. High STIR signal in the C4/5 and C5/6 interspinous regions. Right C5/6 facet joint high STIR signal. Ligamentum flavum is intact.

Case Discussion

This case demonstrates a severe cervical spine injury with a C5 "three column" fracture with retropulsion that contacts the cord resulting in spinal cord oedema with a small contusion. 

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Case Information

rID: 43245
Case created: 1st Mar 2016
Last edited: 2nd Mar 2016
Inclusion in quiz mode: Included

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