Presentation
Fall from height onto occiput. Neck pain, no neurology.
Patient Data
A CT Brain was also completed, with no intra-axial or extra-axial hemorrhage or collection.
CT cervical spine:
There are multiple cortical disruptions involving the C5 vertebral body in both the axial and coronal planes consistent with a comminuted fracture. There is approximately 25% loss of anterior vertebral body height. There is displacement of the C5 vertebral body into the vertebral canal approximately 3 mm resulting in mild vertebral canal stenosis at this level, raising the possibility of ligamentous injury within this region.
There is widening of the C5-6 facet joints measuring 3 mm on the left and on the right. There is likely widening of the C4-5 facet joints as well. Minimally displaced fracture of the left posterior arch of C5.
C5 comminuted fracture with vertical component in a coronal orientation involving the anterior vertebral body and sagittal orientation involving the posterior body indicating axial loading. 3 mm retrolisthesis of C5 on C6 causing mild spinal canal stenosis.
The anterior longitudinal ligament is disrupted at C4-5 and the posterior longitudinal ligament is stripped from the vertebral body at C6, however remains intact.
Left C5/6 facet distraction and likely capsular rupture. Right C5/6 facet demonstrates mild
distraction indicating strain or capsular tear. C5/6 interspinous widening and edema consistent with ligament sprain/partial tear. Ligamentum flavum is intact.
No spinal cord signal abnormality or compression
Case Discussion
These injuries commonly occur as a result of high-energy trauma and often accompanied by a degree of spinal cord injury. Burst fractures are caused by axial compression on a vertebra and characterized by retropulsion of the posterior vertebra into the spinal canal. These fractures are inherently unstable as they involve all three columns.
As time has progressed they are increasingly treated with surgical intervention, even with a severe level of spinal cord compromise, to give the patient the best chance of recovery.
The initial consideration at the time of injury was for operative fixation. Due to the patient's young age and no demonstrated spinal cord injury clinically and on imaging, the decision was made to trial conservative management. He was treated with a hard cervical collar for a minimum of 3 months and reassessed with interval imaging.
The patient recovered well with the use of the hard collar, and it was removed at 3 months post injury.
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