Cervical Hyperextension-Rotation Injury

 Pedicolaminar fracture-separation






Imaging




• Asymmetric hyperextension pattern of injury to posterior column

• Below C2; most common at C6 and C7

• Fracture of articular facet
image Associated with radiculopathy

• Fracture of articular pillar

• Simultaneous fractures of pedicle and ipsilateral lamina = traumatic isolation of cervical articular pillar

• May see degree of rotational deformity at level of injury

• Best imaging modality
image Thin slice (≤ 1 mm) helical CT with sagittal and coronal reformations

image MR (especially STIR) to evaluate ligaments, spinal cord

• Radiographs should include oblique views to evaluate facet alignment, articular pillars


Top Differential Diagnoses




• Hyperflexion injury, cervical

• Hyperflexion-rotation injury, cervical

• Lateral flexion injury, cervical


Pathology




• Rotational instability

• Radiculopathy


Clinical Issues




• Surgical fusion to achieve rotational stability

image
(Left) Axial NECT shows unilateral fractures of the right C6 articular pillar image extending into the lamina image.


image
(Right) Sagittal reformatted CT in the same patient shows extension of the articular pillar fracture into the ipsilateral lamina image.

image
(Left) Coronal reconstructed CT of the hyperextension-rotation injury shows a unilateral comminuted, mildly displaced fracture involving the right C7 articular pillar image.


image
(Right) Axial NECT shows fractures of the right C6 articular pillar image and lamina image, resulting in traumatic isolation of the articular pillar.


TERMINOLOGY


Synonyms




• Pedicolaminar fracture-separation


Definitions




• Hyperextension injury to cervical spine with off-center force vector causing rotation and asymmetric injury


IMAGING


General Features




• Best diagnostic clue
image Asymmetric hyperextension pattern of injury to posterior column

• Location
image Below C2; most common at C6 and C7

• Fracture of articular facet
image Simple fracture or impacted/comminuted

image Fracture of superior articular facet more commonly associated with radiculopathy

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Oct 5, 2016 | Posted by in NEUROLOGICAL IMAGING | Comments Off on Cervical Hyperextension-Rotation Injury

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