What's the Diagnosis? By Abby Renko MD
Wed, 03/10/2021 - 1:49pm
Editor:
A 61 yo F presents to the ED with neck pain after a fall down 15 steps. She denies numbness, weakness or paresthesias in her extremities and has normal strength and sensation on exam. She does have midline tenderness of her cervical spine. A CT of the cervical spine is done and shown below. What's the diagnosis? (scroll down for answer)
Answer: Anterior arch of C1 fracture and base of C2 fracture
- C1 fractures
- Isolated anterior arch fractures- in isolation, not unstable, consider operative intervention
- Jefferson fracture
- burst fracture of the atlas -- fractures of the anterior and posterior arches of C1 (with or without disruption of the transverse ligament)
- Posterior neural arch fracture of C1
- caused by hyperextension--> compresses posterior elements between occiput and spinous process of C2
- C2 fractures
- Isolated body fractures- in isolation, not unstable
- Odontoid Process (dens) fractures
- Type I- throught the tip of the dens -stable
- Type II- fracture at the base of the dens - unstable
- Type III- fracture at the junction of the odontoid and C2 (through lateral masses)- unstable
- Hangman's fracture
- traumatic spondylolisthesis of the axis (bilateral pars interarticularis fracture)
- typically due to extreme hyperextension secondary to abrupt deceleration
- Remember your unstable C-spine fractures! (Jefferson Bit Off A Hangman's Thumb & Pinky)
- Jefferson burst fracture (burst fracture of the atlas of C1)
- Bilateral facet fracture
- Odontoid process fractures (types II and III)
- Any fracture with dislocation
- Hangman's fracture
- Teardrop fracture (fracture of the anterior inferior aspect of cervical vertebral body)
- Posterior neural arch of C1