Ligamentary Injury of the Cervical Spine

Photo Cervical Mri After Whiplash
Fig. 14.17 a This patient suffered a whiplash trauma during a motor vehicle collision. The radiograph in flexion shows a subtle kink at the level C3/C4. b The MR image confirms the disk prolapse at this level.

Ligamentous injuries: Primary ligamentous injuries are of great relevance for any future rehabilitation. They are diagnosed after primary emergency care has been concluded using function studies (Fig. 14.17a) and MRI (Fig. 14.17b).

Spinal column injuries caudal to C3: Giufeng realizes that the so-called "normal spine" begins at C3. Starting at that level the spinal injuries are categorized as:

• Compression fractures (type A)

Flexion-distraction fractures (type B)

The involvement of the posterior edge of the vertebral body is, of course, essential because it indicates a potential hazard to the spinal canal. Fractures of the lower cervical spine mostly evolve in flexion-distraction movement patterns (type B). Any restriction of the spinal column flexibility, such as seen in ankylosing spondylitis (Fig. 14.18a) or Forrestier disease (Fig. 14.18b), increases the risk of unstable fractures even after minor trauma. While Giufeng is still busy studying the radiograph, Greg has already ordered a repeat study: C6 and C7 are not depicted at all. The new radiograph is performed as an oblique view because, even with two strong trauma surgeons pulling the patient's shoulders footward, the cervi-cothoracic transition zone could not be adequately imaged on the lateral projection. The new finding scares the living daylight out of Giufeng (Fig. 14.19). There is a considerable misalignment between C6 and C7: the ligaments of this section must be torn completely. This is a typical torsion injury (C-class spinal injury). The instability can cause a paraplegia. Extreme caution and the stabilization of the cervical spine are warranted.

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