Korean J Radiol.  2004 Dec;5(4):219-224. 10.3348/kjr.2004.5.4.219.

Non-Contiguous Spinal Injury in Cervical Spinal Trauma: Evaluation with Cervical Spine MRI

• Choi SJ
• Shin MJ
• Kim SM
• Bae SJ

• KMID: 1118828
• DOI: http://doi.org/10.3348/kjr.2004.5.4.219

Abstract

OBJECTIVE
We wished to evaluate the incidence of non-contiguous spinal injury in the cervicothoracic junction (CTJ) or the upper thoracic spines on cervical spinal MR images in the patients with cervical spinal injuries. MATER AND METHODS: Seventy-five cervical spine MR imagings for acute cervical spinal injury were retrospectively reviewed (58 men and 17 women, mean age: 35.3, range: 18-81 years). They were divided into three groups based on the mechanism of injury; axial compression, hyperflexion or hyperextension injury, according to the findings on the MR and CT images. On cervical spine MR images, we evaluated the presence of non-contiguous spinal injury in the CTJ or upper thoracic spine with regard to the presence of marrow contusion or fracture, ligament injury, traumatic disc herniation and spinal cord injury. RESULTS: Twenty-one cases (28%) showed CTJ or upper thoracic spinal injuries (C7-T5) on cervical spinal MR images that were separated from the cervical spinal injuries. Seven of 21 cases revealed overt fractures in the CTJs or upper thoracic spines. Ligament injury in these regions was found in three cases. Traumatic disc herniation and spinal cord injury in these regions were shown in one and two cases, respectively. The incidence of the non-contiguous spinal injuries in CTJ or upper thoracic spines was higher in the axial compression injury group (35.3%) than in the hyperflexion injury group (26.9%) or the hyperextension (25%) injury group. However, there was no statistical significance (p > 0.05). CONCLUSION: Cervical spinal MR revealed non-contiguous CTJ or upper thoracic spinal injuries in 28% of the patients with cervical spinal injury. The mechanism of cervical spinal injury did not significantly affect the incidence of the non-contiguous CTJ or upper thoracic spinal injury.

Keyword

Spine, MR; Spine, injuries; Trauma

MeSH Terms

Acute Disease
Adult
Aged
Aged, 80 and over
Cervical Vertebrae/*injuries
Female
Humans
Incidence
Longitudinal Ligaments/injuries
*Magnetic Resonance Imaging
Male
Middle Aged
Retrospective Studies
Spinal Fractures/diagnosis
Spinal Injuries/classification/*diagnosis/epidemiology
Stellate Ganglion/injuries
Thoracic Vertebrae/*injuries
Tomography, X-Ray Computed

Figure

• 

  Fig. 1 T2-weighted sagittal MR image reveals band-like bone marrow contusions (arrowheads) in the upper thoracic spines (T2-4) as well as a prevertebral hematoma (arrows) that resulted from a Jefferson fracture (not shown) in the upper cervical level.

• 

  Fig. 2 A. T1-weighted sagittal MR image shows vertical compression injuries of C5 and C6 (large arrows, CT is not shown) and a burst fracture of T3 (open arrow). Note the discontinuity of the anterior longitudinal ligament (small arrow). B. T2-weighted MR image shows a large prevertebral hematoma (arrowheads) that was caused by injuries in C5-6 and a non-contiguous fracture in T3 (open arrow).

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  Fig. 3 T1- (A) and T2- (B) weighted sagittal MR images in a patient with type III dens fracture (not shown). A. T1-weighted MR image shows compression fracture of C7 (large arrow) and linear prevertebral hemorrhage (small arrows) that resulted from C2 fracture. B. Note the traumatic disc herniation (open arrow) and a focal compressive myelopathy (arrowhead) at the disc level of C7-T1.

• 

  Fig. 4 Non-contiguous ligament injury in a hyperextension cervical spinal injury. T2-weighted MR image reveals a traumatic disc herniation (arrowhead) and anterior longitudinal tear (solid arrow) and interspinous (black arrows) ligament tear in C5-6 due to the distractive extension injury. Note the non-contiguous ligament injury in the anterior longitudinal ligament at the disc level of C7-T1 (open arrow).

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