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November 2008 Radiology Quiz
This patient is a 62 year old male who presents to the ED2 after slipping and falling to the ground. The following Xray is shown.
(You do see interesting cases in ED2)
Questions:
1.Describe what you see?
2. Describe the different types for the above fracture:
- The 3 types of odontoid process fractures are classified based on the anatomic level at which the fracture occurs.
- Type I odontoid fracture is an avulsion of the tip of the dens at the insertion site of the alar ligament. Although a type I fracture is mechanically stable, it often is seen in association with atlanto-occipital dislocation and must be ruled out because of this potentially life-threatening complication.
- Type II fractures occur at the base of the dens and are the most common odontoid fractures. This type is associated with a high prevalence of nonunion due to the limited vascular supply and small area of cancellous bone.
- Type III odontoid fracture occurs when the fracture line extends into the body of the axis. Nonunion is not a major problem with these injuries because of a good blood supply and the greater amount of cancellous bone.
3. Define each of the following:
Anterior spinal cord syndrome
- Anterior spinal cord syndrome involves complete motor paralysis and loss of temperature and pain perception distal to the lesion. Since posterior columns are spared, light touch, vibration, and proprioceptive input are preserved. This syndrome is caused by compression of the anterior spinal artery, which results in anterior cord ischemia or direct compression of the anterior cord. It is associated with burst fractures of the spinal column with fragment retropulsion caused by axial compression.
Central spinal cord syndrome
- This syndrome is caused by damage to the corticospinal tract. It is characterized by weakness, greater in the upper extremities than the lower extremities and more pronounced in the distal aspect of extremity. The syndrome usually is associated with a hyperextension injury in patients with spondylosis or congenital stenosis of the cervical canal. Extension of the cervical spine, causing buckling of the ligamentum flavum into the spinal cord, is believed to cause central spinal cord syndrome.
Brown-Séquard syndrome
- This syndrome involves injury to only 1 side of spinal cord. It causes paralysis, loss of vibration sensation, and loss of proprioceptive input ipsilaterally, with contralateral loss of pain and temperature perception because of involvement of posterior columns and spinothalamic tracts on the same side. It is associated with hemisection of the spinal cord from penetrating trauma; however, it also can be caused by a lateral mass fracture of a cervical vertebra.
4. What would be your management for this patient?
- Nuerosurgery immediately
- Cervical spine immobilization by applying traction with cervical tongs
Trivia: In the movie Almost Famous, what was Penny Lane’s (Kate Hudson’s) real name?
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