SPINAL CASES

Diagnosis: C5 vertebral body fracture with posterior subluxation and retropulsion

Posterior spinal line

Diagnosis: C2 vertebral body fracture with prevertebral soft tissue swelling

Soft tissues more than half the bodywidth

Soft tissues are thicker at C2 than at C4

Diagnosis: C2 (odontoid peg) fracture with posterior displacement

Diagnosis: C2 / C3 displacement in child. This ended up being positional.

Why the soft tissue swelling and malalignment?

Soft tissues swelling: Prominent adenoids and other pharyngeal lymphatic tissue in front of C1, C2, C3 is normal in a child.

Malalignment:Ligaments are more flexible in children, and they are less compliant with positioning. Beware false positives (this required a CT to be safe).

Diagnosis: Thoracolumbar crush fractures. Bones obscured but alignment is wrong.

Diagnosis: Extension teardrop fracture C3. “Avulsion” of ant. longitudinal ligament

Diagnosis: C7 spinous process fracture

Diagnosis: Hangman’s fracture. C2 bilateral pedicle fracture.

Diagnosis: Jefferson fracture. C1 ant. And post. Ring fractures.

Wide C1/C2 interval

Diagnosis: Bilateral facet dislocations, “perched”.

Normal facetjoints

Perched facets

Diagnosis: Chance fracture (“lapbelt injury”).

Chance fractures involve the anterior and posterior elements.

Hyperflexion injuries usually related to lapbelts in MVAs. Note the loss of pedicle outlines on the frontal projection.