This is Barry Belosis, one of the musculoskeletal radiology fellows at Stanford University. 21 year old American football player suffered a cervical spine injury on the field during a competition concerned for cervical spine fracture. This is the patient in this case who underwent CT cervical spine without contrast. In the setting of trauma with concern for cervical spine fracture, CT cervical spine is recommended. Radiographs are not routinely done as they are insensitive with only 47% sensitivity in detecting cervical spine fracture. Here we can see mild anterolesthesis of C4 over C5, and when we move to the lateral side on the left, we can see a perched and fractured C4 facet which is perched on the superior facet of C5. On our axial imaging we can see the left perched facet as seen here with fracture and fracture of the right lamina also demonstrated here. The patient underwent MRI without contrast. In here we can see some disc bulge at C3, C4, and also the anterolesthesis of C4 over C5 with uncovering of the disc at this level. There is also mass effect on the anterior tickle sac and the anterior aspect of the spinal cord at this level. No abnormal cord signal is detected. Additionally, there is an incidental note of a focal syringomyelia at the level of C7 right here. On our sagittal T1 imaging we can again see the perched facet of C4 over C5 and the displaced fracture as we can see here. The other things that we look at is possible epidural hematoma or any kind of abnormal cord signal.

2nd Edition, CASE 51

2nd Edition

Spine

cervical spine injury

anterolisthesis

syringomyelia

CT and MRI findings

American football