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Age: 68

Sex: Male

Indication: Trauma, jumped facets at C6-C7 and C4 left lamina and spinous process fracture on prior CT

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Case #29


Findings

  • Mild residual anterolisthesis at C6-C7 with widening of the anterior disc space and disruption of the anterior longitudinal ligament, the posterior longitudinal ligament, and the ligamentum flavum at this level
  • Additional disruption of anterior longitudinal ligament at the level of C4-C5 as well as possible focal disruption of the posterior longitudinal ligament at C4-C5 and possible focal ligamentum flavum disruption at C3-C4
  • T2/STIR signal hyperintensity in the central aspect of the spinal cord extending from C3-C4 through C6-C7
  • T2/STIR signal hyperintensity in the bilateral C6-C7 facet joints
  • Extensive T2/STIR signal hyperintensity in the interspinous ligaments and supraspinous ligament from the skull base through C6-C7
  • Prevertebral soft tissue thickening and T2/STIR signal hyperintensity throughout the cervical spine extending into the upper thoracic spine
  • T2/STIR signal hyperintensity in the C4 left lamina and spinous process
  • Multilevel posterior disc osteophyte complexes, facet hypertrophy, uncovertebral spurring, and ligamentum flavum thickening contribute to advanced spinal canal stenosis from C4-C5 through C6-C7 and varying degrees of multilevel neural foraminal stenosis, severe bilaterally from C4-C5 through C6-C7


Diagnosis

  • Cord contusion, ligamentous injury

Sample Report

Mild residual anterolisthesis at C6-C7 with widening of the anterior disc space, evidence of bilateral facet capsular injury, and disruption of the anterior longitudinal ligament, the posterior longitudinal ligament, and the ligamentum flavum at this level. Additional disruption of anterior longitudinal ligament at the level of C4-C5 as well as possible focal disruption of the posterior longitudinal ligament at C4-C5 and possible focal ligamentum flavum disruption at C3-C4.

T2/STIR signal hyperintensity in the central aspect of the spinal cord extending from C3-C4 through C6-C7 concerning for cord contusion.

Extensive ligamentous injury involving the interspinous ligaments and supraspinous ligament from the skull base through C6-C7.

T2/STIR signal hyperintensity in the C4 left lamina and spinous process, corresponding with the known fractures.

Prevertebral soft tissue edema throughout the cervical spine extending into the upper thoracic spine.

Background of advanced degenerative changes with multilevel posterior disc osteophyte complexes, facet hypertrophy, uncovertebral spurring, and ligamentum flavum thickening contribute to advanced spinal canal stenosis from C4-C5 through C6-C7 and varying degrees of multilevel neural foraminal stenosis, severe bilaterally from C4-C5 through C6-C7.


Discussion

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Images

Extensive ligamentous injury in the cervical spine including focal disruptions of the anterior longitudinal ligament at two levels (red arrows). Long segment spinal cord contusion (yellow arrows). Sagittal reformatted image from the preceding CT in this patient.



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