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Hyperextension injury of the C1–C2 cervical spine with neurologic deficits: horizontal splitting fracture of the C1 arch A 45-year-old man was admitted to the emergency de- partment of another medical center after a fall from a height of 7 m, accompanied with neck extension. He was transferred to our hospital 2 days after the injury. He was in a quadriplegic state, with Grade 0 motor power of the upper extremity and Frankel classification Grade B on physical examination. The lateral view of a cervical computed tomography (CT) image revealed a Type II odontoid fracture and a splitting fracture of the C1 ante- rior and posterior arches. A normal atlantodens interval was revealed (Fig. 1, Left). A Jefferson fracture was ob- served on the axial view of a CT image. An oblique occip- ital condyle fracture accompanied with an odontoid fracture was revealed on a coronal CT image (Fig. 1, Right). Magnetic resonance imaging revealed a signal change in the spinal cord at the C2 level, and no rupture of the transverse ligament was observed (Fig. 2). The pa- tient underwent an operation 3 days after the injury con- sidering a diagnosis of central cord syndrome with occipital condyle, Jefferson, and odontoid fractures. Ex- cellent reduction and fixation of the dens were confirmed on a postoperative plain radiograph (Fig. 3). Postoperative magnetic resonance imaging performed 5 days after the operation demonstrated the expansion and high density of the signal change in comparison with that before the operation (Fig. 4). Neurologic symptoms of the upper ex- tremity indicated that sensory deficit recovered gradually with time. Woo-Kie Min, MD, PhD Ju-Eun Kim, MD Department of Orthopedic Surgery Kyungpook National University Hospital 130 Dongdeok-ro Jung-gu, Daegu 700-721, South Korea FDA device/drug status: Not applicable. Author disclosures: W-KM: Nothing to disclose. J-EK: Nothing to disclose. Fig. 1. (Left) A sagittal computed tomography image of the cervical spine showing an odontoid oblique fracture with a horizontal splitting fracture of the C1 arch. (Right) A coronal axial computed tomography image of the cervical spine showing a combination of an occipital condyle fracture and the bursting nature of a Jefferson fracture at the C1 level. http://dx.doi.org/10.1016/j.spinee.2014.09.031 1529-9430/Ó 2015 Elsevier Inc. All rights reserved. The Spine Journal 15 (2015) 370–372
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The Spine Journal 15 (2015) 370–372
Hyperextension injury of the C1–C2cervical spine with neurologicdeficits: horizontal splitting fractureof the C1 arch
A 45-year-old man was admitted to the emergency de-partment of another medical center after a fall froma height of 7 m, accompanied with neck extension. Hewas transferred to our hospital 2 days after the injury.He was in a quadriplegic state, with Grade 0 motor powerof the upper extremity and Frankel classification Grade Bon physical examination. The lateral view of a cervicalcomputed tomography (CT) image revealed a Type IIodontoid fracture and a splitting fracture of the C1 ante-rior and posterior arches. A normal atlantodens intervalwas revealed (Fig. 1, Left). A Jefferson fracture was ob-served on the axial view of a CT image. An oblique occip-ital condyle fracture accompanied with an odontoidfracture was revealed on a coronal CT image (Fig. 1,Right). Magnetic resonance imaging revealed a signalchange in the spinal cord at the C2 level, and no rupture
Fig. 1. (Left) A sagittal computed tomography image of the cervical spine showi
arch. (Right) A coronal axial computed tomography image of the cervical spine
nature of a Jefferson fracture at the C1 level.
http://dx.doi.org/10.1016/j.spinee.2014.09.031
1529-9430/� 2015 Elsevier Inc. All rights reserved.
of the transverse ligament was observed (Fig. 2). The pa-tient underwent an operation 3 days after the injury con-sidering a diagnosis of central cord syndrome withoccipital condyle, Jefferson, and odontoid fractures. Ex-cellent reduction and fixation of the dens were confirmedon a postoperative plain radiograph (Fig. 3). Postoperativemagnetic resonance imaging performed 5 days after theoperation demonstrated the expansion and high densityof the signal change in comparison with that before theoperation (Fig. 4). Neurologic symptoms of the upper ex-tremity indicated that sensory deficit recovered graduallywith time.
Woo-Kie Min, MD, PhDJu-Eun Kim, MD
Department of Orthopedic SurgeryKyungpook National University Hospital
130 Dongdeok-roJung-gu, Daegu
700-721, South Korea
FDA device/drug status: Not applicable.
Author disclosures: W-KM: Nothing to disclose. J-EK: Nothing to
disclose.
ng an odontoid oblique fracture with a horizontal splitting fracture of the C1
showing a combination of an occipital condyle fracture and the bursting
Fig. 3. A lateral radiograph of the cervical spine showing bicortical screw
placement for the C2 odontoid fracture.
Fig. 2. A T2-weighted axial magnetic resonance image of the cervical
spine showing no significant transverse ligament rupture, and a T2-
weighted sagittal magnetic resonance image of the cervical spine showing
a preoperative high-signal change of the spinal cord at the C2 level.
371W.-K. Min and J.-E. Kim / The Spine Journal 15 (2015) 370–372
Fig. 4. A T2-weighted sagittal magnetic resonance image of the cervical
spine taken 5 days after the operation showing an extended and higher sig-
nal change than that observed on the preoperative image.
372 W.-K. Min and J.-E. Kim / The Spine Journal 15 (2015) 370–372
