J Korean Soc Magn Reson Med.  2014 Sep;18(3):232-243. 10.13104/jksmrm.2014.18.3.232.

The Secondary Contiguous or Non-contiguous Subchondral Bone Impactions in Subaxial Cervical Spinal Injury: Incidence and Associated Primary Injury Patterns

• Han JG
• Kim YJ
• Yoon SH
• Cho KJ
• Kim E
• Kang YH
• Lee HY
• Cho SG
• Kim MY

• KMID: 1999923
• DOI: http://doi.org/10.13104/jksmrm.2014.18.3.232

Abstract

PURPOSE
To evaluate the incidence of secondary contiguous or non-contiguous subchondral bone impactions (SBI) in subaxial cervical spinal injury and associated primary injury patterns.
MATERIALS AND METHODS
A retrospective review of computed tomography, magnetic resonance imaging, and medical records was carried out for 47 patients who had sustained a subaxial cervical spinal injury. Presence, number, level, and sites of secondary contiguous or non-contiguous SBI were recorded. To evaluate primary injury patterns, the level and number of primary injury sites of subaxial cervical spine injury, injury morphology, anterior/posterior discoligamentous complex (ADC/PDC) injury, posterior ligamentous complex (PLC) injury, spinal cord injury, and mechanism of injury (MOI) were analyzed. Differences in primary injury pattern of subaxial cervical spine injury and MOI between patients with and without SBI, and between contiguous or non-contiguous SBI were analyzed using the Mann-Whitney U test, Pearson's chi square test and Fisher's exact test.
RESULTS
Eighteen patients (18/47, 38.29%) had developed contiguous (n=9) or non-contiguous (n=9) SBI, most commonly involving T3 (15/47, 31.91%) and 3 levels (6/18, 33.33%). All SBIs had developed near the anterosuperior region of the body and the superior endplate and were the result of a high-impact MOI. SBIs were statistically significant in association with injury morphology and PLC injury (P=0.001, P=0.009, respectively) at the primary injury site. Non-contiguous SBI was more frequently accompanied by upper cervical spinal injuries in association with PDC injuries, as opposed to contiguous SBI, with statistical significance (P=0.009), while no other statistically significant differences were found.
CONCLUSION
Secondary SBIs are common and probably associated with subaxial cervical spinal injuries with high energy compressive flexion forces.

Keyword

Subaxial cervical spine; Subchondral bone impaction; Magnetic resonance imaging (MRI); Injury pattern

MeSH Terms

Humans
Incidence*
Ligaments
Magnetic Resonance Imaging
Medical Records
Retrospective Studies
Spinal Cord Injuries
Spinal Injuries*
Spine

Figure

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  Fig. 1 A graph of the number of the primary injury level in patients with (+) and without (-) SBI.

• 

  Fig. 2 A graph of the number of vertebrae according to the level of contiguous and non-contiguous secondary SBI.

• 

  Fig. 3 A graph of the number of the primary injury level in patients with contiguous and non-contiguous SBI.

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  Fig. 4 Images of a 36-year-old man with non-contiguous SBIs in a subaxial cervical spinal injury. Saggital CT images (a, b) show anterior translation of C4 on C5 with right unilateral facet locking with fractures, representing translation morphology according to the SLIC system. Sagittal STIR (c) and contrast enhanced T1-weighted MR images with fat suppression (d), showing non-contiguous SBIs at the vertebral body near the superior endplates from C7 to T3 (arrows). High signal intensity is noted at the interspinous area of C1-2 and C4-5 level (white arrowheads in c), suggesting posterior ligamentous complex injury. There is also irregularly high signal intensity at the posterior portion of the disc, with herniation at the C4-5 level (black arrowhead in c), representing posterior discoligamentous complex injury.

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  Fig. 5 Images of a 58-year-old man with contiguous SBIs in subaxial cervical spinal injury. STIR (a) and sagittal contrast enhanced T1-weighted MR images with fat suppression (b) show mild anterior translation of the C6 vertebral body on C7, representing translation morphology. Contiguous SBIs are seen near the superior endplates from the T1 to the T3 level (arrows in a, b). High signal intensity is noted at the interspinous area of the C6-7 level (arrowhead in a), representing posterior ligamentous complex injury.

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