Jefferson fracture types11/13/2023 ![]() The sturdy alar ligaments extend from the lateral margins of the odontoid process to the medial margins of the foramen magnum bilaterally to limit atlanto-axial rotation. Three ligaments constrain the movement of the atlanto-axial articulation (Fig. In the atlanto-axial articulation, the fovea dentis, a small rounded facet in the medial portion of the anterior arch of C1, articulates with the odontoid process of the C2 anteriorly, allowing the atlas and skull to rotate as a unit about the vertical axis of the dens. The configuration of the deep articular sockets and tight joint capsule allows for approximately 20° flexion-extension while constraining both rotation and lateral flexion. In the atlanto-occipital articulation, the occipital condyles rest within the superior facets of the lateral masses of the atlas. The articulations of the atlanto-occipital (C0-C1) and atlanto-axial (C1-C2) joints are distinct from those of the middle and lower cervical spine. In addition, the wide range of motion of the cervical spine (80-90° flexion, 70° extension, 20-45° lateral flexion, and 90° rotation to each side) and complex kinematics contribute to vulnerability to extreme mechanical forces. Injury to the cervical spine is common in major trauma because of the relative lack of supporting structures when compared to the thoracic or lumbar spine. T2 images with and without fat saturation identify epidural fluid collections, ligamentous disruption, oedema, and herniated discs. T1 sequences are excellent for surveying the anatomy and caliber of the spinal cord. Additionally, in patients with confirmed cervical spine injury on MDCT, MRI can more fully evaluate the extent of associated soft tissue injuries. MRI is the modality of choice for the assessment of extra-osseous injuries such as epidural haematomas and ligamentous disruption in patients with negative CT studies but a high index of suspicion for injury. MRI is a critical follow-up study in patients with severe trauma to the cervical spine. MDCT may detect epidural and subdural haematomas however small collections may be overlooked. MDCT is excellent for the timely detection of bony injuries, hematomas involving the paravertebral soft tissues, and signs of subcutaneous soft tissue trauma. With this technique, a high-spatial-resolution thin-section axial data set can be acquired with reformats in the sagittal and coronal planes in algorithms optimised for evaluation of bones and soft tissues. In most emergency departments, MDCT is the fastest and most practical study for cervical spine injury following trauma. Instability may cause abnormal interspinous and interpedicular distances, or cervical malalignment.įractures of the foramen transversarium are associated with vertebral arterial dissection. Injury to one of the three spinal columns may be stable, and injuries to more than one are unstable. MDCT rapidly evaluates the bones, and MRI is superior for detecting ligament and cord injuries. MDCT and MRI are complementary and both may be needed to define injuries and determine management. Thus, it is essential that radiologists be able to differentiate between a stable and unstable injury on MDCT, as this information ultimately helps determine the management of such injuries. ConclusionĬervical spine injuries are approached with much caution by emergency room clinicians. Magnetic resonance imaging is useful for evaluation of the supporting ligaments and the spinal cord after the patient has been stabilised. The proliferation of multidetector computed tomography allows for fast and accurate screening for potential bony and vascular injuries. Most cervical spine injuries follow motor vehicle accidents, falls, and violence. Devastating neurological injury, including complete and incomplete tetraplegia, are common sequelae of cervical spine trauma and cause profound and life-altering medical, financial, and social consequences. Cervical spine injuries following major trauma result in significant associated morbidity and mortality.
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