What's the Diagnosis? By Abby Renko MD

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