Cervical, Chronic Post-Traumatic Abnormality

Julia Crim, MD

DIFFERENTIAL DIAGNOSIS

Common

Less Common

Osteomyelitis, C1-C2
Crystalline Arthropathies
- Gout, calcium pyrophosphate deposition disease, hemodialysis arthropathy

ESSENTIAL INFORMATION

Key Differential Diagnosis Issues

Single level &/or upper cervical degenerative disease suggests prior injury
Wide surgical decompression without fusion often yields unstable spine with secondary deformity
Ossification of anterior longitudinal ligament (ALL) known as DISH when > 4 adjacent levels affected
- May see smaller foci of ossification due to trauma, aging, or seronegative arthropathy
- Look for other signs of trauma to help make distinction
- Small foci of ossification ALL distinguished from trauma by normal configuration of underlying vertebra
Posterior element injuries not uncommonly missed acutely
- Malalignment, focal degenerative disease signs suggest prior injury
Fracture nonunion sometimes difficult to determine
- Prolonged failure of bridging callus
  - Time to healing depends on age, health, and fracture location
- Sclerosis of apposing fracture margins
Craniocervical instability due to multiple causes
- Trauma
- Arthritis: Rheumatoid arthritis, seronegative, calcium pyrophosphate deposition disease
- Congenital: Achondroplasia, trisomy 21
- Infection
Kyphosis, scoliosis due to many causes
- Short curve deformities suggest trauma, infection, congenital, or tumor