Pseudotrauma of the spine; the osseous variants
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Imaging of Trauma: Pseudotrauma of the spine
I n t e g r a t i ve I ma g i n g • R e v i ew
OSSEOUS VARIANTS THAT MAY SIMULATE INJURY
AJR 2012; 199:1200–1206
Robert B. Carr, Kathleen R. Tozer Fink, Joel A. Gross Department of Radiology, University of Washington, Harborview Medical Center, Seattle, WA. Reviewed by Thorsang Chayovan
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OBJECTIVE
Anatomic variants
Incomplete ossification/fusion
Erroneous diagnosis
Common imaging findings that may present as pseudotrauma—focus on CT.
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Outline
• Injuries to the spinal column
• Normal development of the spine
• Variants—the pseudotrauma
– C1
– C2
– C3 – L5
– Miscellaneous; motion artifact
• Summary
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Injuries to the spinal column
• Common in blunt trauma
• Up to 15% of blunt trauma patients have a TL-spine fracture
• Initial evaluation: radiography and CT
• Errorneous diagnosis
=> Anatomic variants
=> Incomplete development
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Normal Development
C1-2 Lower
Vertebrae
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Normal Development
C1-2 Lower
Vertebrae
Unique pattern of ossification
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Normal ossification of atlas
3 Primary ossification centers
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Normal ossification of axis 5 Primary ossification centers
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Normal ossification of axis
Secondary ossification center: os terminale
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C3-L5 3 Primary ossification centers
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VARIANTS
C1
C2
C3-L5
Miscellaneous
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ATLAS C1
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Atlas C1
Incomplete fusion
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Atlas C1
Cleft Fracture
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Atlas C1
Anterior midline cleft
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Atlas C1
Ossified posterior atlantooccipital membrane
“Arcuate foramen”
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Atlas C1
Partially ossified
posterior atlantooccipital membrane
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AXIS C2
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Axis C2
Incomplete fusion
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Ossific density at cranial aspect of odontoid process
Os terminale
Os odontoideum
Odontoid fracture
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Axis C2
Os terminale Persistent os terminale
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Axis C2
Os odontoideum Odontoid fracture
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Axis C2
Pseudosubluxation of C-spine in children
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Axis C2
Pseudosubluxation of C-spine in children
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C3 – L5
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C3
Anterior wedging
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C3 – L5
Cleft in transverse foramen
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C3 – L5
Fracture VS Secondary ossification center
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C3 – L5
Fracture VS Secondary ossification center
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C3 – L5
Disc herniation
between
ring apophysis
and vertebra
=> Limbus vertebra
>> Common in
L-spine
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Schmorl node
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C3 – L5
Clefts
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C3 – L5
Clefts
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MISCELLANEOUS CONDITION
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Motion artifacts
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Summary
Atlas C1
• Incomplete fusion – Symmetric, non-displaced
• Partially ossified post. Atlantooccipital mb.
Axis C2
• Incomplete fusion – Linear sclerotic line with
surrounding lucency
• Persistent os terminale
• Os odontoideum
• Ant. Pseudosubluxation of C2-3 in children
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Summary
C3 – L5
• Ant. Wedging of C-vertebrae in children
• Clefts in transverse foramen
• Incomplete fusion
• Limbus vertebrae—L-spine
• Schmorl node
• Clefts – Spinous process
– Pars interarticularis
– Pedicle
– Lamina
Miscellaneous
• Motion artifact
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Conclusion
Recognition of the normal developing spine and variants can prevent an incorrect diagnosis of injury and inappropriate treatment.
THANK YOU