Exercise: Spine Trauma

 EXERCISE 13-3. SPINE TRAUMA

13-8.  What  is  the  most  likely  diagnosis  in  Case  13-8(Figure 13-23)?

A.         Abnormality of bone density

B.         Disruption of facet joints at multiple levels

C.         Subluxation of L4 over L5

D.         12 compression fracture with kyphotic angulation

13-9.   Regarding  the  patient  in  Case  13-9  shown  in Figure 13-24, which of the following is true?

A.         The condition probably predated the trauma.

B.         The prospects for a full recovery are good.

C.         Surgical repair will likely be successful.

D.         The patient will probably never have normal

E.         The spinal cord is intact.

13-10. In Case 13-10, the MRI in Figure 13-25 most likely demonstrates delayed posttraumatic syrinx.

A.         subluxation.

 

B.         spinal cord tumor.

 

C.         abnormal bone marrow

Radiologic Findings

13-8. In this case, there is a compression fracture of the L2 vertebral body with kyphotic angulation (E is the correct answer to Question 13-8).

13-9. In this case, the sagittal T1-weighted MR image shows a complete subluxation of C6 on C7 and a complete transection of the cervical spinal cord at that level. In all likelihood this patient will never regain use of her legs or have any normal neurologic function below C6 (D is the correct answer to Question 13-9).

13-10. In this case, the sagittal T2-weighted MR image shows a high signal abnormality (arrow) within the upper thoracic spinal cord, and on the axial T2-weighted image, an epicenter in the central canal region is con-firmed. This is a typical appearance of syringomyelia or syrinx (A is the correct answer to Question 13-10).

Discussion

Spinal trauma is a major medical problem, usually caused by motor vehicle and occupational accidents. Accurate and complete diagnosis is essential to maintain spine stability and ensure preservation of neurologic function. As mentioned previously, plain films are commonly obtained initially. How-ever, additional imaging tests are often necessary to fully eval-uate a case of spine trauma, especially in high-risk injury cases, patients with clinical signs and symptoms, or those with altered cognition. In Case 13-8, there was clinical con-cern that the spinal canal was compromised. Small bony frag-ments within the spinal canal may not be visible with plain film alone. For this reason, CT was performed (Figures 13-26 A, B). This allowed a better appreciation of the extent of the fractures and ruled out neural compression. An example of spinal canal compromise is shown in Figure 13-26 C.

In severe trauma, the spinal cord may be affected. Contu-sions may occur with or without fracture/subluxation, and MR imaging would be required for diagnosis. In a severe fracture/subluxation, the spinal cord can be completely tran-sected. In Case 13-9, the patient was known to have a severe C6-7 subluxation, but because of obesity, plain film and CT imaging were very limited. In this case, only MR imaging was able to demonstrate the full extent of her spinal cord injury.

Rarely, patients who have recovered from an acute spinal injury experience a delayed onset of neurologic symptoms, occurring 1 to 15 years after the trauma. This suggests the possibility of delayed posttraumatic syrinx (Case 13-10). Symptoms include pain on coughing or exertion, sensory disturbances, or motor deficits. MR imaging is essential for diagnosis. The condition is sometimes amenable to surgical shunting. Syringomyelia can also be idiopathic or can be sec-ondary to certain congenital or inflammatory conditions. Imaging often cannot distinguish among different possible etiologies, and history is important.