Pediatric Cervical Spine Fracture

Etiology: trauma
Imaging: in 0-10 year old do CT of occiput -> C3, in >10-18 year old do CT of occiput -> T1
Clinical: 80% of spine injuries affect cervical spine, in < 8 years old they affect C1-C3

Radiology Cases of Cervical Spine Fracture

Radiology Cases of C1 Cervical Spine Fracture

CT of C1 vertebral body fracture — Axial CT without contrast of the cervical spine shows a lucency through the anterior arch of the C1 vertebral body.

Radiology Cases of C1 Jefferson Cervical Spine Fracture

CT of fracture of C1 vertebral body / Jefferson fracture — Axial CT without contrast of the cervical spine shows lucencies through the left anterior and posterior arches of the C1 vertebral body with minimal displacement of the fracture fragments.

CT of fracture of C1 vertebral body / Jefferson fracture — Axial CT without contrast of the cervical spine (upper left) shows lucencies through the left anterior and posterior arches of the C1 vertebral body with displacement of the fracture fragments. Coronal 2-D reconstruction (lower left) and the 3-D reconstruction (right) which simulates an open-mouth odontoid radiograph shows the lateral masses of the C1 vertebral body are now wider than the lateral masses of the C2 vertebral body.

Radiology Cases of C2 Cervical Spine Fracture

CT of fracture / distraction of C2 vertebral body — Sagittal (left) and coronal (right) 2D reconstructions from a CT without contrast of the cervical spine shows an oblique lucency through the C2 vertebral body with distraction of the fracture fragments. There is marked prevertebral soft tissue swelling throughout the cervical spine.

Radiology Cases of C2 Hangman Cervical Spine Fracture

CT of C2 vertebral body / Hangman fracture — Axial CT without contrast of the cervical spine (top) shows a lucency extending through the left C2 facet and another lucency extending through the right transverse process and involving the right transverse foramen which raised concern for possible right vertebral artery injury which was ruled out on a subsequent CT angiogram of the neck. Sagittal 2D reconstructions from the left, center and right of the cervical spine shows lucencies through the left C2 facet (left image), right transverse process (right image) and anterior inferior aspect of the C2 vertebral body (center 2 images).

CT of fracture of C2 vertebral body / Hangman fracture — Axial CT without contrast of the cervical spine (upper left) shows lucencies through both pedicles of the C2 vertebral body. Midline sagittal 2D reconstruction (upper right) shows anterior dislocation of the C2 vertebral body on the C3 vertebral body. Left sagittal (lower left) and right sagittal 2D reconstructions (lower right) again show lucencies through the bilateral C2 pedicles and bilateral anterior perching of the C2 inferior facets on the C3 vertebral body.

Radiology Cases of Lower Cervical Spine Fracture

CT of compression fracture of C7 vertebral body — Coronal (left) and sagittal (right) 2D reconstructions from a CT without contrast of the cervical spine show lucencies through the anterior and posterior aspects of the C7 vertebral body with loss of vertebral body height noted best on the sagittal image.

CT of compression fracture of C6 vertebral body — Axial (above) and coronal (left below) 2D reconstruction from CT without contrast of the cervical spine shows a lucency through the center of the C6 vertebral body. Sagittal 2D reconstruction (lower right) shows loss of height of the C6 vertebral body.

CT of fracture of the left pedicle of the C6 vertebral body — Axial CT (left) without contrast of the cervical spine with sagittal 2D reconstruction (right) shows a lucency through the left pedicle of the C6 vertebral body.

CT of fracture / dislocation of C6 vertebral body with perched facets — Sagittal 2D reconstructions from a CT without contrast of the cervical spine shows the C6 vertebral body displaced anteriorly in relation to the C7 vertebral body (left) and anterior perching of the left inferior C6 facet (middle) and right inferior C6 facet (right) upon the C7 vertebral body.

Radiology Cases of C7 Clay Shoveler Cervical Spine Fracture

CT of C7 spinous process fracture / Clay shoveler fracture — Axial and sagittal 2D reconstruction from a CT without contrast of the cervical spine shows a lucency through the middle part of the spinous process of the C7 vertebral body.

CT and MRI of C7 spinous process fracture / Clay shoveler fracture — Lateral radiograph of the cervical spine shows a lucency through the middle part of the spinous process of the C7 vertebral body. Sagittal STIR MRI without contrast of the cervical spine shows bright signal representing edema in the interspinous ligaments between the C6-C7 and C7-T1 vertebral bodies.

Radiology Cases of Retroclival Hematoma

CT of retroclival hematoma — Sagittal 2D reconstruction from CT without contrast of the cervical spine shows a rounded area of increased density inferior to the tip of the clivus and superiorly and posteriorly to the C2 vertebral body.