Abstract
Injuries to the spinal column are common and road traffic accidents are the commonest cause. Subaxial cervical spine (C3–C7) trauma encompasses a wide spectrum of osseous and ligamentous injuries, in addition to being frequently associated with neurological injury. Multidetector computed tomography (MDCT) is routinely performed to evaluate acute cervical spine trauma, very often as first-line imaging. MDCT provides an insight into the injury morphology, which in turn reflects the mechanics of injury. This article will review the fundamental biomechanical forces underlying the common subaxial spine injuries and resultant injury patterns or “fingerprints” on MDCT. This systematic and focused analysis enables a more accurate and rapid interpretation of cervical spine CT examinations. Mechanical considerations are important in most clinical and surgical decisions to adequately realign the spine, to prevent neurological deterioration and to facilitate appropriate stabilisation. This review will emphasise the variables on CT that affect the surgical management, as well as imaging “pearls” in differentiating “look-alike” lesions with different surgical implications. It will also enable the radiologist in writing clinically relevant CT reports of cervical spine trauma. Teaching Points • Vertebral bodies and disc bear the axial compression forces, while the ligaments bear the distraction forces.• Compressive forces result in fracture and distractive forces result in ligamentous disruption.• Bilateral facet dislocation is the most severe injury of the flexion-distraction spectrum.• Biomechanics-based CT reading will help to rapidly and accurately identify the entire spectrum of injury.• This approach also helps to differentiate look-alike injuries with different clinical implications.
Highlights
Injuries to the spinal column are frequently seen in clinical practice
Injuries of the subaxial cervical spine occur along a wide spectrum of severity, from minor soft tissue “strains” to disastrous fracture dislocations with extensive spinal cord mutilation
In this article we review the fundamental traumatic forces that cause subaxial cervical spine injuries and illustrate their associated Multidetector computed tomography (MDCT) findings
Summary
Injuries to the spinal column are frequently seen in clinical practice. The commonest cause of these injuries is road traffic accidents [1]. Additional vectors like rotation and lateral flexion can result in complex hyperflexion-rotation injury This represents axial loading in which the motion segment is flexed and a compressive force is applied at the anterosuperior margin of the vertebral body, the centre of rotation remaining in front of the anterior column, resulting in compressive failure of the anterior column (Fig. 7). With increasing force, tensile failure of the posterior disc, PLL and PLC occurs resulting in a highly unstable injury This is often described as a flexion teardrop fracture, the most severe form of hyperflexion injury with fracture-dislocation of the involved motion segment (Fig. 8). CT features of PLC injury include: interspinous widening, interlaminar widening; facet joint distraction subluxation or dislocation, widened posterior disc space, focal kyphosis and anterior subluxation of the vertebral bodies Three critical surgical questions can be answered by biomechanics and injury vector based CT analysis: 1. Is there a mechanical instability that needs surgical stabilisation?
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