C2 Body Research Articles

Posterior pharyngeal wall position in the production of speech.

The posterior pharyngeal wall has been assumed to be stationary during speech. The present study examines this assumption in order to assess whether midsagittal widths in the pharyngeal region can be inferred from measurements of the anterior pharyngeal wall. Midsagittal magnetic resonance images and X-ray images were examined to determine whether the posterior pharyngeal wall from the upper oropharynx to the upper laryngopharynx shows anterior movement that can be attributed to variables in speech: vowel quality in both English and Japanese; vowels versus consonants as classes of speech sounds; sustained versus dynamically produced speech; and isolated words versus sentences. Measurements were made of the distance between the anterior portion of the vertebral body and the pharyngeal wall. The first measurement was on a line traversing the junction between the dens and the body of the second cervical vertebra (C2). The next three measurements were on lines at the inferior borders of the bodies of C2, C3, and C4. The measurements showed very little movement of the posterior pharyngeal wall, none of it attributable to speech variables. Therefore, the position of the posterior pharyngeal wall in this region can be eliminated as a variable, and the anterior portion of the pharynx alone can be used to estimate vocal cavities.

Evaluation of axial and flexural stresses in the vertebral body cortex and trabecular bone in lordosis and two sagittal cervical translation configurations with an elliptical shell model

Background: Osteoarthritis and spinal degeneration are factors in neck and back pain. Calculations of stress in clinically occurring configurations of the sagittal cervical spine are rare. Objective: To calculate and compare combined axial and flexural stresses in lordosis versus cervical configurations in anterior and vertical sagittal head translated positions. Design: Digitized measurements from lateral cervical radiographs of 3 different shapes were used to calculate axial loads and bending moments on the vertebral bodies of C2-C7. Methods: An elliptical shell model was used to model horizontal cross-sections of the vertebral bodies of C2 through T1. Axial and flexural stresses were calculated with short compression block equations. Elliptical shell modeling permitted separation of stresses into cortical and inner medullary regions. Digitized radiographic points were used to create polynomials representing the shape of the sagittal cervical curvatures from C1 to T1. To calculate bending moments at each vertebral segment, moment arms from a vertical line through C1 were determined from digitizing. Results: Compared with the normal lordosis, stresses on the anterior vertebral body cortical margins of C5-T1 in the sagittal translated postures are compression rather than tension. At the posterior vertebral bodies in the anteriorly translated position and vertically translated postures, the stresses change from compression to tension at C5 through T1. In absolute value (ABS) compared with values at the same segments in a normal lordosis, the magnitude of the combined anterior stresses in the sagittal postures are higher at C5-C7 (eg, ABS[σstraight/σnormal] ≃ 1.25 to 4.25). Conclusions: Vertebral body stresses are reversed in direction at C5-T1 in sagittal translated postures compared to a normal lordosis. Stress analysis, with implications for bone remodeling, indicates that both sagittal head translation postures, anterior head carriage, and vertical head translation, are undesirable configurations in the cervical spine. (J Manipulative Physiol Ther 2002;25:391-401)

Rear pharyngeal wall placement during vowel production

While the rear pharyngeal wall has been assumed to be stationary during speech, this needs to be confirmed. The present study used midsagittal magnetic resonance images to determine whether the posterior pharyngeal wall shows vowel-specific movement during the sustained production of 11 English vowels. Distances were measured between the most posterior portion of the vertebral body and the pharyngeal wall at four points. The first traversed the junction between the dens and body of the second vertebra (C2). The next three traversed the inferior border of the bodies of C2, C3, and C4. These ranged from a level just below the velopharyngeal port to one near the larynx. In preliminary measurements for one speaker, only the uppermost location showed significant variation due to vowel quality; at the other locations, differences were less than 1 mm. Further subjects are being studied. These findings confirm, at least for vowels, the assumption that the rear pharyngeal wall is stationary during speech. Therefore, midsagittal distances in the pharyngeal region can be inferred from measurements of the anterior pharyngeal wall in relation to the fixed features of the vocal tract. [Work supported by NIH Grant DC-02717.]

Experimental investigation of failure load and fracture patterns of C2 (axis)

The injury mechanism and magnitude of failure load of C2 fractures are important in the clinical treatment of its fixation. The magnitudes of the failure load of C2 and the mechanism of injury in vivo are uncertain. Accordingly, nine C2 vertebrae obtained from cadaver spines, ranging in age from 51 to 80 years, were used for the study. Special restraint conditions were applied to yield specific fracture of C2. With the posterior element potted postero-anteriorly up to one-quarter of the inferior facet, posterior shear force ranging from 840 to 1220 N was required to cause fracture across the pars interarticularis. For odontoid fracture study, a special rig was fabricated to encapsulate the body of C2 in a cell using ISOPON, and a thin layer of ISOPON sandwiched between the inferior facets and two lateral plates. The assembled rig permits slight sagittal movement of C2 about the cup lateral pivot supports. Failure load of between 900 and 1500 N was recorded for odontoid fracture. These values are in agreement with published data. The experiment carried out under these two different restraint conditions had specifically resulted in different fractures of C2. In reality, depending on factors such as the inclination of this force vector applied to the head, the precise posture at the time of trauma, the spinal geometry, and the physical properties, different types of fracture patterns of C2 may be produced. This additional data will be useful in the biomechanical study of C2 vertebra using analytical approaches, and in surgical anterior/posterior fixation using screws.

Actinomycose vertébrale avec compression médullaire. À propos d’un cas

Introduction. – Vertebral involvement of actinomycosis is extremely rare and associated spinal cord compression is unusual. Exegesis. – We report a case of a 31-year-old man with vertebral actinomycosis presenting with spinal cord compression. Magnetic resonance imaging demonstrated a paravertebral abscess and lytic areas on the vertebral body of C5 requiring emergency surgery and antibiotic treatment. The patient was still asymptomatic after 12 months of follow-up. Conclusion. – Clinical aspects of this unusual localization are reviewed. Treatment may be particularly difficult.

Comparison of axial and flexural stresses in lordosis and three buckled configurations of the cervical spine

Objective. To calculate and compare combined axial and flexural stresses in lordosis versus buckled configurations of the sagittal cervical curve. Design. Digitized measurements from lateral cervical radiographs of four different shapes were used to calculate axial loads and bending moments on the vertebral bodies of C2–C7. Background. Osteoarthritis and spinal degeneration are factors in neck and back pain. Calculations of stress in clinically occurring configurations of the sagittal cervical spine are rare. Methods. Center of gravity of the head (inferior–posterior sella turcica) and vertebral body margins were digitized on four different lateral cervical radiographs: lordosis, kyphosis, and two “S”-shapes. Polynomials (seventh degree) and stress concentrations on the concave and convex margins were derived for the shape of the sagittal cervical curvatures from C1 to T1. Moments of inertia were determined from digitizing and the use of an elliptical shell model of cross-section. Moment arms from a vertical line through the center of gravity of the head to the atlas and scaled neck extensor moment arms from the literature were used to compute the vertical component of extensor muscle effort. Segmental lever arms were calculated from a vertical line through C1 to each vertebra. Results. In lordosis, anterior and posterior stresses in the vertebral body are nearly uniform and minimal. In kyphotic areas, combined stresses changed from tension to compression at the anterior vertebral margins and were very large (6–10 times as large in magnitude) compared to lordosis. In kyphotic areas at the posterior vertebral body, the combined stresses changed from compression (in lordosis) to tension. Conclusions. The stresses in kyphotic areas are very large and opposite in direction compared to a normal lordosis. This analysis provides the basis for the formation of osteophytes (Wolff's Law) on the anterior margins of vertebrae in kyphotic regions of the sagittal cervical curve. This indicates that any kyphosis is an undesirable configuration in the cervical spine. Relevance Osteophytes and osteoarthritis are found at areas of altered stress and strain. Axial and flexural stresses at kyphotic areas in the sagittal cervical spine are abnormally high.

The effect of single-handed cricoid pressure on cervical spine movement after applying manual in-line stabilisation — a cadaver study

Six adult cadavers had 40 N cricoid pressure applied using a cricoid ‘yoke’ whilst maintaining manual in-line stabilisation of the cervical spine. No other spinal supports were used. Lateral radiographs were taken before and after applying pressure to the cricoid cartilage and the degree of cervical spine movement accurately determined. The median vertical displacements measured from the body of C5 and two other reference points (A and B) on the cervical spine were 0.5 mm (range 0–1.5 mm) and 0.5 mm (range 0–3 mm), respectively. There was no disruption to the lines formed by the anterior or posterior borders of the cervical bodies. We have been unable to demonstrate that single-handed cricoid pressure causes clinically significant displacement of the cervical spine in a cadaver model. This conflicts with previous studies.

Hedgehogs and Zonoids

Let R be a continuous real function on the unit sphere Sn of (n+1)-dimensional Euclidean space Rn+1. We prove that the maph:Sn→R,p↦∫Sn|〈p, q〉|R(q)dσ(q),where 〈·, ·〉 is the standard inner product and σ the spherical Lebesgue measure, is of class C2. It follows that the boundaries of zonoids (resp. generalized zonoids), whose generating measure have a continuous density with respect to σ, can be considered as hedgehogs (envelopes parametrized by their Gauss map) with a C2 support function. We deduce a local property for such zonoids. We give a formula for the curvature function of the hedgehog defined by h and we deduce a necessary and sufficient condition for h being the support function of a convex body of class C2+. We define projection hedgehogs (resp. mixed projection hedgehogs) and interpret their support functions in terms of n-dimensional volume (resp. mixed volume). Finally, we consider the extension of the classical Minkowski problem to hedgehogs.

Acute respiratory compromise associated with flexed cervical traction after C2 fractures.

Acute respiratory compromise is occasionally observed in a subgroup of patients with upper spinal injuries involving the C2 vertebrae. A retrospective review was performed to identify fracture types and risk factors for early respiratory deterioration following injury to the upper cervical spine. To examine the frequency of respiratory complications encountered following traction manipulation of specific upper cervical spinal injuries involving the C2 vertebrae. Major complications related to cervical skeletal traction are uncommon. Respiratory compromise with occasional mortality has been observed. Risk factors for acute respiratory failure are unknown. The medical records of 166 consecutive patients with fractures of the C2 vertebrae admitted between January 1994 and July 1998 to a regional spinal cord injury center were examined. Demographic data, injury subtype, fracture displacement, respiratory status, treatment method, and outcome at discharge were examined. Patients with comorbidities compromising respiratory function were excluded. One hundred fifty-five patients met the inclusion criteria of this study. Sixty-one patients had Type II odontoid fractures of which 53 were displaced (32 posteriorly and 21 anteriorly). In addition, there were 21 patients with Type III odontoid fractures, 33 with axis C2 body fractures, 32 with Hangman's fractures, and eight patients with an os odontoideum. Thirteen of 32 patients with posteriorly displaced odontoid fractures experienced acute respiratory compromise following reduction with cervical skeletal traction and immobilization, while only three of the remaining 123 patients had respiratory difficulties. Respiratory distress as a consequence of cervical spine fractures resulted in three deaths. Two of these patients had posteriorly displaced Type II odontoid fractures whose airway could not be emergently intubated. Frequent respiratory deterioration (40% of patients) during acute management of posteriorly displaced Type II odontoid fractures after reduction was observed. Physicians must be aware that cervical flexion in the treatment of posteriorly displaced odontoid fractures may significantly increase the risk of airway obstruction due to the presence of acute retropharyngeal swelling. This may be avoided with elective nasotracheal intubation in this upper cervical spine fracture subtype.

Relationships of cervical, thoracic, and lumbar bone mineral density by quantitative CT.

The purpose of this work was to compare, using quantitative CT (QCT), vertebral bone mineral density (BMD) in the cervical, thoracic, and lumbar spine in healthy volunteers. QCT of the vertebral bodies of C2, C5, T12, and L4 was performed on 50 healthy volunteers (25 women, 25 men; mean age 31.7 years). Trabecular BMD analysis was performed at each level. Mean BMDs (mg/cm3 calcium hydroxyapatite) for women and men were highest at C5 (BMD women/men 341.6/300.6 mg/cm3) and C2 (297.2/269.6 mg/cm3) and lowest at T12 (193.1/184.9 mg/cm3) and L4 (186.2/180.1 mg/cm3). The BMD of C2 was statistically significantly different from that of C5, T12, and L4 (p < 0.0001) for both genders. Also, the BMD of C5 differed significantly from that of T12 and L4 (p < 0.0001). The BMD of C5 showed significant gender differences (p = 0.002). Correlation coefficient showed a strong correlation between the BMD of T12 and L4 for both genders (women, r = 0.67; men, r = 0.90). Trabecular BMD of C2 and C5 measured by QCT is significantly higher than trabecular BMD of T12 and L4 in nonosteoporotic volunteers of both genders.

Effect of surgical cricothyrotomy on the unstable cervical spine in a cadaver model of intubation

Cricothyrotomy is indicated for patients who require an immediate airway and in whom orotracheal or nasotracheal intubation is unsuccessful or contraindicated. Cricothyrotomy is considered safe with cervical spine (c-spine) injury; however, the amount of c-spine movement that occurs during the procedure has not been determined. In this experimental study, an established cadaver model of c-spine injury was used to quantify movement during cricothyrotomy. A complete C5–6 transection was performed by using an osteotome on 13 fresh-frozen cadavers. Standard open cricothyrotomy was performed on each cadaver, with c-spine images recorded in real time on fluoroscopy, then transferred to video and Kodachrome still images. Outcome measures included movement across the C5–6 site with regard to angulation expressed in degrees of rotation and linear measures of axial distraction and anterior-posterior (AP) displacement expressed as a proportion of C5 body width. Data were analyzed by using descriptive statistics to determine mean change from baseline in each of three planes of movement. Significance was assumed if 95% confidence intervals did not include zero. A significant amount of movement was observed with regard to AP displacement (6.3% of C5 width) and axial distraction (−4.5% of C5 width, indicating narrowing of the intervertebral space). These correspond to 1–2 mm AP displacement and less than 1 mm axial compression. No significant angular displacement was observed. In conclusion, cricothyrotomy results in a small but significant amount of movement across an unstable c-spine injury in a cadaver model. This degree of movement is less than the threshold for clinical significance.

Gliosarcoma metastatic to the cervical spinal cord: case report and review of the literature

BACKGROUND We describe a case of an intramedullary metastasis to the cervical spinal cord from a temporal gliosarcoma. CASE DESCRIPTION A 48-year-old man with known temporal lobe gliosarcoma presented with a new onset of ipsilateral hemiparesis. A MRI scan revealed the presence of an intramedullary lesion in the spinal cord behind the body of C2. Despite repeated craniotomy, radiation, and chemotherapy, the patient succumbed to a rapidly progressive disease. CONCLUSION The case illustrates the ability of gliosarcoma to metastasize to other locations in the neuroaxis. We believe this to be the first case report of an intramedullary spinal cord metastasis from a gliosarcoma. The pathological features and available literature are reviewed.

The fat C2 sign.

A fat C2 sign results from an obliquely oriented fracture, involving the body of C2, that causes displacement of either one or both of the anterior and posterior margins and creates an increased anteroposterior distance between the two surfaces. The degree of obliquity of the fracture plane with respect to the coronal plane will determine whether the actual fracture will be visualized on the lateral radiograph (1). This injury may occur as a result of isolated hyperflexion or hyperextension forces or of combined hyperflexion and hyperextension. There may also be some component of vertical loading or distraction in these injuries (2). The fracture plane gains obliquity when there is some rotational component in the stress forces. The identification of a fat C2 sign implies that a potentially unstable fracture with fragment displacement is present and that further imaging evaluation is needed (Fig 2).

Effects of cervical spine immobilization technique and laryngoscope blade selection on an unstable cervical spine in a cadaver model of intubation

Study Objective: Orotracheal intubation (OTI) is commonly used to establish a definitive airway in major trauma victims, with several different cervical spine immobilization techniques and laryngoscope blade types used. This experimental, randomized, crossover trial evaluated the effects of manual in-line stabilization and cervical collar immobilization and 3 different laryngoscope blades on cervical spine movement during OTI in a cadaver model of cervical spine injury. Methods: A complete C5-C6 transection was performed by using an osteotome on 14 fresh-frozen cadavers. OTI was performed in a randomized crossover fashion by using both immobilization techniques and each of 3 laryngoscope blades: the Miller straight blade, the Macintosh curved blade, and the Corazelli-London-McCoy hinged blade. Intubations were recorded in real time on fluoroscopy and then transferred to video and color still images. Outcome measures included movement across C5-C6 with regard to angulation expressed in degrees of rotation and axial distraction and anteroposterior displacement with values expressed as a proportion of C5 body width. Cormack-Lehane visualization grades were also recorded as a secondary outcome measure. Data were analyzed by using multivariate analysis of variance to test for differences between immobilization techniques and between laryngoscope blades and to detect for interactions. Significance was assumed for P values of less than.05. Results: Manual in-line stabilization resulted in significantly less movement than cervical collar immobilization during OTI with regard to anteroposterior displacement. Use of the Miller straight blade resulted in significantly less movement than each of the other 2 blades with regard to axial distraction. The Cormack-Lehane grade was significantly better with manual in-line stabilization versus cervical collar immobilization; no differences were observed between blades. Conclusion: Manual in-line stabilization results in less cervical subluxation and allows better vocal cord visualization during OTI in a cadaver model of cervical spine injury. The Miller laryngoscope blade allowed less axial distraction than the Macintosh or Corzelli-London-McCoy blades. The clinical significance of this degree of movement is unclear. [Gerling MC, Davis DP, Hamilton RS, Morris GF, Vilke GM, Garfin SR, Hayden SR. Effects of cervical spine immobilization technique and laryngoscope blade selection on an unstable cervical spine in a cadaver model of intubation. Ann Emerg Med. October 2000;36:293-300.]

Fatal Airway Compromise Due to Retropharyngeal Hematoma after Airbag Deployment

In trauma patients it is possible for a hematoma to form in the potential space between the pharynx and cervical spine (the retropharyngeal space). Fewer than 30 cases of actual airway obstruction secondary to retropharyngeal hematomas have been reported. We present an unusual case of an elderly woman who was involved in a minor motor vehicle collision which deployed her airbag. She died as a result of anoxic injury to the brain. Autopsy results demonstrated transverse fractures through the bodies of C5 and C7 with associated significant retropharyngeal and mediastinal hematoma. Airbags have been shown to significantly decrease the mortality rate in frontal collisions; however, the potential for hyperextension injuries from airbag deployment exists, especially if the occupant is unrestrained, small, or sitting too close to the airbag. When this woman's airbag deployed, it most likely caused her vertebral fractures, hematoma, subsequent airway compromise, and anoxic brain injury. Whatever the mechanism of trauma, one must be cognizant of the potential risk for retropharyngeal hematoma and airway compromise when a patient presents with injury to the cervical spine.

Pitfalls in Spinal Radiology: Association between the Hangman's fracture and an extension teardrop fracture of the body of C2

No abstract available.

Fenómeno de Lhermitte en tres pacientes oncológicos

Lhermitte's sign was first described by Pierre Marie and Chatelin in 1917. Lhermitte published his report in 1920 and reviewed this in 1924. This phenomenon is characterized by the occurrence of an electric shock-like sensation going along the spine in a cervico-caudal direction with flexion of the neck, and may also be felt in the upper and lower limbs. Clinical cases. Case 1. A 49 year-old woman diagnosed as having breast cancer and being treated with cisplatin presented with Lhermitte's sign. On physical examination the osteotendinous reflexes were absent but the abdominal cutaneous reflexes were present. There was reduced sensitivity to vibration. Case 2. An 80 year-old man, previously operated on for adenocarcinoma of the colon, without further treatment, presented with progressive weakness of all four limbs and Lhermitte's syndrome. On examination there was obvious weakness of all four limbs, with the sensory level at C3. A cervical MR scan showed a metastasis in the vertebral body of C3 with epidural involvement and compression of the spinal cord. Case 3. A 54 year-old man was being treated by radiotherapy for cancer of the larynx. He presented at the onset of Lhermitte's sign but MR and physical examination were normal. Lhermitte's sign is non-specific, although in oncological patients a detailed clinical history and examination should be done seeking data regarding chemotherapy, radiotherapy and spinal compression.

Circumferential cervical surgery for spondylostenosis with kyphosis in two patients with athetoid cerebral palsy

BACKGROUNDPatients with athetoid cerebral palsy may develop severe degenerative changes in the cervical spine decades earlier than their normal counterparts due to abnormal cervical motion.METHODSTwo patients, 48 and 52 years of age, presented with moderate to severe myelopathy (Nurick Grades IV and V). MR and 3-dimensional CT studies demonstrated severe spondylostenosis with kyphosis in both patients. This necessitated multilevel anterior corpectomy with fusion (C2-C7, C3-C7) using fibula and iliac crest autograft and Orion plating, followed by posterior wiring, fusion using Songer cables, and halo placement.RESULTSPostoperatively, both patients improved, demonstrating only mild or mild to moderate (Nurick Grades II and III) residual myelopathy. Although both fused posteriorly within 3.5 months, the patient with the fibula graft developed a fracture of the anterior C7 body with mild anterior graft migration, and inferior plate extrusion into the C7-T1 interspace. However, because he has remained asymptomatic for 9 months postoperatively, without dysphagia, removal of the plate has not yet been necessary.CONCLUSIONSPatients with athetoid cerebral palsy should undergo early prospective cervical evaluations looking for impending cord compromise. When surgery is indicated, circumferential surgery offers the maximal degree of cord decompression and stabilization with the highest rate of fusion.

Role of clinical examination in screening for blunt cervical spine injury

Background: The purpose of this study was to evaluate the hypothesis that awake and alert blunt trauma patients with Glasgow Coma Scores of 14 or 15 (regardless of blood ethanol level or other injuries sustained) can be effectively evaluated with clinical examination without radiographic evaluation of the cervical spine. Study Design: During a 32-month period at an urban Level 1 Trauma Center, 2,176 consecutive blunt trauma patients who presented with Glasgow Coma Scores of 14 or 15 were prospectively evaluated by trauma resident housestaff. Housestaff performed physical examinations of the neck and questioned the patients for the presence of neck pain. Following study form documentation of the cervical neck examination, a lateral cervical spine x-ray was performed. Further studies such as swimmer’s view and CAT scan were performed if the lateral x-ray could not completely evaluate C1 to C7. These further studies were considered part of the lateral cervical spine (c-spine) x-ray screen. Attending radiologists performed final x-ray interpretations. Results: The study consisted of 2,176 patients, 33 (1.6%) of whom were diagnosed with cervical spine injury. Of the 33 patients with cervical spine injury, 3 had negative clinical examinations (sensitivity, 91%). Lateral c-spine x-ray screen was negative in 1 of these 3 patients. The 2 patients with negative c-spine clinical examination but positive lateral c-spine x-ray screens were diagnosed with C2 spinous process fracture and C6–C7 body fractures. Thirteen patients with negative lateral c-spine screens (sensitivity, 61%) were diagnosed with cervical spine injury. We evaluated 463 patients with blood ethanol levels greater than 100 mg/dL, and 6 (1.3%) were diagnosed with c-spine injury. No injuries were missed on clinical examination in this subgroup with elevated blood ethanol levels. Conclusions: 1) Clinical examination of the neck can reliably rule out significant cervical spine injury in the awake and alert blunt trauma patient. Addition of lateral c-spine x-ray does not improve the sensitivity of clinical examination in the diagnosis of significant cervical spine injury. 2) Elevated ethanol level is not a contraindication to the use of clinical examination as the screening tool for cervical spine injury. Level of consciousness, as determined by Glasgow Coma Score, is a more effective criterion to dictate a screening method for cervical spine injury.

POST TRAUMATIC PSEUDOMENINGOCELE

A case of traumatic avulsion of the brachial plexus presenting as multiple cervical pseudomeningoceles following a fall from bicycle is presented. Two wheeler accidents may result in severe distraction of arm with dural tears. Overall they are rare causes of nerve root or spinal trauma. Case Report A 15-year-old boy presented with complaints of persistent loss of movement of right shoulder and right upper limb associated with loss of sensation along lateral aspect of upper arm and distal to the elbow following a fall from a bicycle 2 months ago. He had also fractured the olecranon process and the medial condyle of right side ulna and humerus respectively. These injuries were managed conservatively. On examination he had grade o/V power in muscle groups of the right shoulder with wasting of the supraspinatus, infraspinatus and deltoid, and winging of the right scapula. He had loss of sensation over C5-7 dermatomes. He was provisionally diagnosed as having right brachial plexus injury. Routine investigations were within normal limits. Myelogram revealed no obstruction to the flow of contrast in the spinal subarachnoid space. A bulbous outpouching was seen emerging from the right sided neural foramen C5-6 in both frontal and lateral projections. This was followed by computed tomomyelography (CTM) of the cervical spine from C2 to T1 levels with 5 mm sections at vertebral body level and 1 mm sections at disc level. The study revealed anteroposterior compression fracture of the body of C7 with a chip fragment lying on the right side. There was a tear of right root sleeve at C7-T1 disc level resulting in formation of a post traumatic pseudomeningocele extending over a length of 1.85 cm having a width of .45cm (Fig 1). There was also pressure effect on right anterolateral aspect of thecal sac at this level. There was another root sleeve tear at the level of C5-6 with a relatively smaller pseudomeningocele protruding from the right neural foramen (Fig 2). Open in a separate window Fig. 1 CTM reveals anteroposterior compression fracture of body of C7 vertebra with pseudomeningocele (arrows) at C7-T1 level.