Cervical, Lower, Post-Traumatic Bony Abnormality

Julia Crim, MD

DIFFERENTIAL DIAGNOSIS

Common

Subaxial Cervical Spine Fractures
- Hyperflexion Injury, Cervical
- Posterior Column Injury, Cervical
- Burst Fracture, Cervical
- Hyperflexion-Rotation Injury, Cervical
- Lateral Flexion Injury, Cervical
- Hyperextension Injury, Cervical
- Hyperextension-Rotation, Cervical
- Pathologic Vertebral Fracture
- Shear Injury
Post-Traumatic Deformity
- Accelerated Degeneration
- Facet Arthropathy, Cervical
- Kyphosis
- Scoliosis
Nontraumatic Entities that Mimic Trauma
- Ossification of Anterior Longitudinal Ligament
- Metastases, Lytic Osseous
- Rheumatoid Arthritis, Adult
- Juvenile Idiopathic Arthritis
- Klippel-Feil Spectrum
- Post-Operative Change, Normal
- Facet Arthropathy, Cervical
- Incomplete Fusion, Posterior Element
- Osteomyelitis, Pyogenic

Less Common

ESSENTIAL INFORMATION

Key Differential Diagnosis Issues

Evaluate for post-traumatic instability with flexion/extension views
- Not accurate in 1st week after injury

Helpful Clues for Common Diagnoses

Signs of acute injury
- Malalignment, focal kyphosis, or lordosis
- Soft tissue swelling (not always present)
- Fracture line
Signs of remote trauma
- Cervical deformity
- Single level facet osteoarthritis
MR very helpful in questions of acuity of injury, and distinguishing trauma from trauma mimics
- Look for bone marrow edema on fluid sensitive sequences
Trauma mimics
- Ossification of anterior longitudinal ligament: No bone donor site visible
- Growth disturbance in congenital and childhood disorders
- Infection: Vertebral endplates eroded
- Metastatic disease
  - May see round or oval bone lesion, or involvement of entire vertebral body
  - Cortex destroyed not just disrupted as in trauma
- Incomplete fusion shows smoothly contoured margins, unlike trauma