Ortho Case of the Week – C-Spine Answers
Case 1: An adult male is BIBEMS after an MVC as the unrestrained driver.
1. What is the diagnosis based on the imaging above?
Hangman’s fracture, also known as traumatic spondylolisthesis.
This is a bilateral C2 pedicle fracture, with anterior translation of C2 on C3 and increased interspinous distance from C1 to C2.
2. What is the mechanism that results in this pathology?
Forced neck extension (typically of an already extended neck)
Most commonly in diving accidents and motor vehicle accidents. It has also historically been seen in judicial (not suicidal) hangings.
Case 2: A 22-year-old male is BIBEMS in a c-collar with neck pain after a dive injury.
3. What is the diagnosis based on the imaging above?
Jefferson fracture, a burst fracture of the atlas (C1).
There are fractures of the anterior and posterior arches of C1. On the open mouth odontoid view there is displacement of the lateral masses away from the dens. A distance of greater than 6 mm suggests ligamentous injury.
4. What is the mechanism that results in this pathology?
Axial loading which results the occipital condyles being driven into the lateral masses of C1. Typical mechanism of injury is diving headfirst into shallow water.
Case 3: A 25-year-old male is BIBEMS after an MVC with polytrauma.
5. What is the diagnosis based on the imaging above?
Atlanto-occipital dissociation
The atlantooccipital joints are widened bilaterally (orange arrows), with an increased basion-dens interval (orange line).
Source: Radiopaedia
6. What is the mechanism that results in this pathology?
This typically results from a pure flexion injury involving C1-C2.
Case 4: A 25-year-old male is BIBEMS after an MCC, unable to move his legs.
7. What is the diagnosis based on the imaging above?
Bilateral facet dislocation
Bilateral anterior dislocation of the facet joints (C6-C7 level) causing distortion to the spinal canal
8. What is the mechanism that results in this pathology?
It has been traditionally thought to result from hyperflexion such as rapid deceleration. However, may also result from a buckling force.
Case 5: A 25-year-old male is BIBEMS after he crashed his mountain bike. He is unable to move any of his extremities.
9. What is the diagnosis based on the imaging above?
Flexion teardrop fracture
Flexion teardrop fracture at C4 consisting of a fracture of the anterior inferior portion of the vertebral body and fracture of the anterior portion of the C5 vertebral body.
10. What is the mechanism that results in this pathology?
Severe flexion (it’s in the name). This leads to the collision between superior and inferior vertebral bodies resulting in this fracture pattern. Typically seen in shallow water diving and motor vehicle accidents.
Case 6: A 30-year-old male is BIBEMS after an MVC with neck pain. He has no neurologic deficits on exam.
11. What is the diagnosis based on the imaging above?
Odontoid fracture, grade II, which have the highest rates of nonunion
12. What is the mechanism that results in this pathology?
In elderly patients, most commonly secondary to simple ground level falls.
In younger patients, typically results from more severe blunt trauma to head leading to cervical hyperflexion or hyperextension.