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Spine and spinal cord injuries. Spine and spinal cord injuries mechanisms of spine injuries. flexion injury extension injury axial loading rotation injury. Spine and spinal cord injuries mechanism. flexion injury Cervical and thoracic spine thoracolumbar junction

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Spine and spinal cord injuries mechanisms of spine injuries
Spine and spinal cord injuriesmechanisms of spine injuries

  • flexion injury

  • extension injury

  • axial loading

  • rotation injury


Spine and spinal cord injuries mechanism
Spine and spinal cord injuriesmechanism

  • flexion injury

  • Cervical and thoracic spine thoracolumbar junction

  • Vertebral body fracture with anterior wedging

  • extension injury

  • Cervical spine !

  • Fractures of posterior elements (posterior column), with ligaments disruption subluxations and spodylolisthesis

  • NOTE! In this mechanism the spinal cord injury and root compression may occur without evident osseous changes visible on plain films


Spine and spinal cord injuries mechanism1
Spine and spinal cord injuriesmechanism

  • axial loading

  • C spine – diving L-S spine – jumping

  • compression („burst”) fractures of vertebral bodies lateral element (processes fractures) and articular pillar fractures

  • rotation injury

  • Usually in combination with flexion-extension injury

  • Lateral mass fractures, luxations, uncovertebral dislocations


Spine and spinal cord injuries effects
Spine and spinal cord injurieseffects

  • oseous changes, fractures

  • posttraumatic instabilities and spondylolistheses

  • posttraumatic disc herniations

  • spinal cord contusion

  • spinal cord compression

  • vascular spinal cord injury


Spine and spinal cord injuries1
Spine and spinal cord injuries

  • Osseous changes – most important sings

  • atlantooccipital dislocation

  • common, but not always fatal

  • on lateral plain film: dens – basion distance > 12,5 mm

  • most common to C1 is a bilateral vertical fracture through the neural arch = aJefferson fracture = a burst fracture that involves both anterior and posterior arches


Spine and spinal cord injuries

Jefferson fracture – of C1 anterior and posterior arches :

The burst mechamism causes the lateral displacement of the lateral parts of C1

Posterior arch C1 fracture



Spine and spinal cord injuries

Odontoid – dense fracture

C2 fracture, is often combined with luxation of C1 – may efect with spinal cord compression; CT with MPR and 3D reconstructions is advisable


Spine and spinal cord injuries

Flexion-extension mechanism:

avulsion fracture C5

spinous process fracture C7

C 2 on CT

C 5

C 7



Spine and spinal cord injuries2
Spine and spinal cord injuries odontoid fractures - luxation

  • Osseous changes – most important sings

  • Odontoid (dens) fractures

  • Usually at the base of dens – poorly visible on axial CT – MPRs and 3Ds necessary!

  • Hangman’s fracture bilateral transpedicle with the separation of neural arch from the vertebral body and spondylolisthesis, dens and ligaments are usually intact


Spine and spinal cord injuries
Transverse C2 body fracture – Hangman’s fracture - odontoid fractures - luxationwith bilateral arch-body separation – the result is instability


C2 dens apex fracture unvisible on plain film
C2 dens apex fracture odontoid fractures - luxationunvisible on plain film!


C2 dens apex fracture unvisible on axial ct
C2 dens apex fracture odontoid fractures - luxationunvisible on axial CT!


C2 dens apex fracture visible on mpr
C2 dens apex fracture odontoid fractures - luxationvisible on MPR!


C2 dens apex fracture visible on 3d ssd
C2 dens apex fracture odontoid fractures - luxationvisible on 3D SSD!

Spinal canal stenosis can be evaluated


Spine and spinal cord injuries3
Spine and spinal cord injuries odontoid fractures - luxation

  • Osseous changes – most important sings

  • C1-C2 luxations

  • in all methods:plain films,CTand MR:

  • normal distance between anterior arch of C1 and dens of C2 is 1 to 3 mm

  • distances between dens and lateral masses of C1 should be

  • equal

  • luxation – spondylolisthesis is important when larger than

  • 3-4 mm

  • NOTE ! Arches and processes fractures are common at C6, i C7 and in L-S spine


C1 c2 luxation plain film rheumatoid arthritis malum suboccipitale
C1-C2 luxation odontoid fractures - luxationplain film(Rheumatoid arthritis) malum suboccipitale

> 3 mm


C1 c2 luxation mr t1w rheumatoid arthritis malum suboccipitale
C1-C2 luxation odontoid fractures - luxationMR T1w(Rheumatoid arthritis) malum suboccipitale


C1 c2 luxation mr t2w rheumatoid arthritis malum suboccipitale
C1-C2 luxation odontoid fractures - luxationMR T2w(Rheumatoid arthritis) malum suboccipitale


Body and arches of c2 arches of c3 luxation ct mpr and 3d ssd
Body and arches of C2 + arches of C3, luxation odontoid fractures - luxation(CT MPR and 3D SSD)


Spine and spinal cord injuries

spondylolisthesis odontoid fractures - luxation



Transpedical fracture with spondylolisthesis c6 c7 ct mpr
Transpedical fracture with spondylolisthesis C6-C7 odontoid fractures - luxation(CT MPR)


Spine and spinal cord injuries4
Spine and spinal cord injuries odontoid fractures - luxation

  • Osseous changes – most important sings

  • Compression („burst”) and multifragment fractures of vertebral bodies may cause free osseuos fragments protrusion to the spinal canal, resulting with spinal cord damage or/and compression

  • free or protruding osseous fragments are well seen on CT especially with MPRs and 3D SSD reconstructions

  • Spiral or multislice CT can be used to evaluate the spinal canal stenosis caused by fractures or spondylolistheses and precisely define the location of the most threatening fragments


Spine and spinal cord injuries

Compression „burst” fracture (C5) odontoid fractures - luxation


Burst fracture l s 3d ssd
Burst fracture L-S 3D SSD odontoid fractures - luxation


Spine and spinal cord injuries5
Spine and spinal cord injuries odontoid fractures - luxation

Posttraumatic spinal cord compression is caused by:

·       haematoma

-        epidural

-        or inside the cord

·       disc herniation

·       spondylolisthesis or luxation

·       osseous fragments


Spine and spinal cord injuries6
Spine and spinal cord injuries odontoid fractures - luxation

·CT visualize

-        osseous changes

-       spinal canal stenosis

-       disc herniation

-       rarely haematoma


Spine and spinal cord injuries7
Spine and spinal cord injuries odontoid fractures - luxation

  • ·    MR visualize

  • -    cord oedema

  • haematoma, contusion, vascular injury

  • -    disc damage and herniation

  • -    osseous changes are poorly visualized on MR - use CT!

  • -    Instead MR perfectly visualizes spinal cord displacement, compression and focal lesions !


Posttraumatic cord oedema
Posttraumatic cord oedema odontoid fractures - luxation


Spine and spinal cord injuries8
Spine and spinal cord injuries odontoid fractures - luxation

Spinal cord contusion

·   bleeding foci within the cord grey matter

-    best visible on MR

- on CT visible while massive

-    on CT hyperdense foci inside the cord

(60 – 70 HU)

-    on MR image is phase dependent


Spine and spinal cord injuries9
Spine and spinal cord injuries odontoid fractures - luxation

Spinal cord contusion MR

# acute phase 1- 4 days – slightly hyperintense on T2w, hypointense w T1w

# subacute phase 2-4 days up to 3 weeks – slightly hyperintense on T2w, hyperintense on T1w

# chronic phase more than 3 weeks – strongly hyperintense on T1 & T2w, accompanied by:

-        oedema – high signal on T2w

-        malacia – inhomogenous, high signal on T2w

# residual – glial scar and myelomalacia


Spine and spinal cord injuries10
Spine and spinal cord injuries odontoid fractures - luxation

vascular spinal cord injury

-  caused by compression, vasospasm or damage of the spinal vessels

-  resulting ischaemia leeds to necrosis and myelomalacia

- Well seen onMR: hypointense on

T1w and hyperintense on T2w


Contusion oedema bleeding disc herniation
Contusion, oedema, bleeding, disc herniation odontoid fractures - luxation


Contusion oedema bleeding disc herniation1
Contusion, oedema, bleeding, disc herniation odontoid fractures - luxation