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Cervical Spine Fractures
Cervical Spine Fractures
FRACTURES
Cervical Anatomy
Biomechanically Specialized
Support of large Cranial mass
Large range of motion
Flexion/extension
Axial rotation
C1 - Atlas
No body
2 articular pillars
Flat articular surface
Vertebral artery
foramen
2 arches
Anterior
Posterior
Vertebral artery groove
C2 Anatomy
Dens
Embriological C1 body
Base poorly vascularized
Osteoporotic
superolateral
AtlantoAxial Anatomy
TectorialMembrane
AtlantoAxial Anatomy
TranverseLigament
C1C2joint
occiput
C1
C2
AlarLigament
AtlantoAxial Anatomy
Facetfor
Occipital
Condyle
Transverse
Ligament
AtlantoAxial Anatomy
Vertebral
Artery
Cervical Views
ue
q
i
l
Ob
Odontoid
AP
Swimmers View
LATERAL VIEW
C1-C2
Predental space
C3-C7
FACE
T
JOINT
INTERVERT
EBRAL
DISC
SPACE
S
Prevertebral Soft
Tissue
10m
m
(adult)
Retropharyngeal spaceC 2-C4
5mm
22mm
AP View
Odontoid View
An adequate film should include the
entire odontoid and the lateral borders
of C1-C2.
Occipital condyles should line up with
the lateral masses and superior
articular facet of C1.
The distance from the dens to the
lateral masses of C1 should be equal
bilaterally.
The tips of lateral mass of C1 should
line up with the lateral margins of the
superior articular facet of C2.
The odontoid should have
uninterrupted cortical margins
blending with the body of C2.
Classification of
Fractures of c-spine
HYPERFLEXION
INJURIES
extention injuries
Hangman fracture
Extention teardrop fracture
laminar fracture
Pillar fracture
Posterior arch of c1 fracture
FRACTURE
Jefferson fracture
Burst fracture
OTHER
INJURIES
Odontoid fracture
Rotational Injuries
Hyperflexion
Distraction creates
tensile forces in
posterior column
Can result in
compression of
body (anterior
column)
Most commonly
results from MVC
and falls
Compression
Result from axial
loading
Commonly from
diving, football, MVA
Injury pattern
depends on initial
head position
May create burst,
wedge or
compression fxs
Hyperextension
Impaction of posterior
disruption of ALL
Evaluate carefully for
stability
LOOK FOR CENTRAL
CORD SYNDROME
Types of Injuries
Signs:
Prevertebral swelling
associated with anterior
longitudinal ligament tear.
Teardrop fragment from
anterior vertebral body
avulsion fracture.
Posterior vertebral body
subluxation into the spinal
canal.
Spinal cord compression
from vertebral body
displacement.
Fracture of the spinous
process.
Fracture of
the spinous
process of
C4
anteriorly
Wedge fracture
Wedge shape
vertebra
Antersuperio
r body
fracture
Best
seen on lateral
view
Hyperextention injury
Stable fracture ?
Type I (65%)
hair-line fracture
C2-3 disc normal
Type II (28%)
displaced C2
disrupted C2-3 disc
ligamentous rupture with
instability
C3 anterosuperior compression
fracture
Type III (7%)
displaced C2
C2-3 Bilateral interfacet dislocation
Severe instability
Prevertebral soft
tissue swelling
Anterior
HANGMAN
TYPE
dislocation of FRACTURE
the
3 C2 vertebral body
BILATRAL C2 pars
interarticularis
fractures.
The CT-images
confirm the
fracture-lines of
the hangman's
fracture.
They run through
the pars
interarticularis
resulting in a
traumatic
spondylolysis.
In this case there
was no neurologic
deficit, because
the spinal canal is
widened at the
level of the
fracture.
This injury is
stable in flexion
but highly unstable in extension.
SIGNS ON XRAY:
Displacement of the
lateral masses of
vertebrae C1 beyond the
margins of the body of
vertebra C2.
<2mm bilateral is always
abnormal
<1-2 mm or unilateral
displacement can be due
to head rotation
CT is required to
1. define the extent of fracture
2. detecting fragment in spinal cord
Odontoid Fracture C2
Classification
Type I: Avulsion of the tip of
the dens where it is attached
to C1.
This is a rare fracture.
It is potentially stable.?
Type II: Through the base of
the dens.
Most common fracture.
Always unstable and poor
healing.
Type III: Fracture through the
body of the axis and
sometimes facets.
Can be unstable, but has a
better prognosis than type II
due to better healing of the
fracture which runs through
the metaphyseal body of C-2
Type II
Type III
CT IMAGE
DENS
Dens
The image through the lateral part of C2 nicely shows, that the fracture runs
through the body of C2, i.e. a type III odontoid fracture.
The posterior dura is in a normal position, but the anterior dura is displaced
(arrow).
Case 1
5 yo girl
Hit by car while
riding bike
VSA at scene
Vitals recovered
by EMS
Atlanto-Occipital
Dislocation
Radiographic Lines
Powers Ratio
BC/OA
>1 considered abnormal
Limited Usefulness
Positive only in Anterior
Translational injuries
False Negative with pure
distraction
QUESTIONS
REFERRENCES
Text Book of Radiology and imaging
(DAVID SUTTON)
Primer of Diagnostic Imaging
Radiology Review Manual(Dahnert)
Thank You!