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

OBJECTIVE

Anatomic variants

Incomplete ossification/fusion

Erroneous diagnosis

Common imaging findings that may present as pseudotrauma—focus on CT.

Outline

• Injuries to the spinal column

• Normal development of the spine

• Variants—the pseudotrauma

– C1

– C2

– C3 – L5

– Miscellaneous; motion artifact

• Summary

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

Normal Development

C1-2 Lower

Vertebrae

Normal Development

C1-2 Lower

Vertebrae

Unique pattern of ossification

Normal ossification of atlas

3 Primary ossification centers

Normal ossification of axis 5 Primary ossification centers

Normal ossification of axis

Secondary ossification center: os terminale

C3-L5 3 Primary ossification centers

VARIANTS

C1

C2

C3-L5

Miscellaneous

ATLAS C1

Atlas C1

Incomplete fusion

Atlas C1

Cleft Fracture

Atlas C1

Anterior midline cleft

Atlas C1

Ossified posterior atlantooccipital membrane

“Arcuate foramen”

Atlas C1

Partially ossified

posterior atlantooccipital membrane

AXIS C2

Axis C2

Incomplete fusion

Ossific density at cranial aspect of odontoid process

Os terminale

Os odontoideum

Odontoid fracture

Axis C2

Os terminale Persistent os terminale

Axis C2

Os odontoideum Odontoid fracture

Axis C2

Pseudosubluxation of C-spine in children

Axis C2

Pseudosubluxation of C-spine in children

C3 – L5

C3

Anterior wedging

C3 – L5

Cleft in transverse foramen

C3 – L5

Fracture VS Secondary ossification center

C3 – L5

Fracture VS Secondary ossification center

C3 – L5

Disc herniation

between

ring apophysis

and vertebra

=> Limbus vertebra

>> Common in

L-spine

Schmorl node

C3 – L5

Clefts

C3 – L5

Clefts

MISCELLANEOUS CONDITION

Motion artifacts

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

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

Conclusion

Recognition of the normal developing spine and variants can prevent an incorrect diagnosis of injury and inappropriate treatment.

THANK YOU