A 57-year-old man is transferred to your facility after being thrown from an all-terrain vehicle. He was not wearing a helmet and was documented to have loss of consciousness. Upon arrival, his primary complaint is severe headache. He gives no significant medical history.
Initial assessment shows a male on a backboard with full cervical spine immobilization. His Glasgow Coma Scale score is 14, with a blood pressure of 130/83 mm Hg and a heart rate of 87 beats/min. He has several abrasions on his face, but his pupils are equal and react well. His heart and lungs appear to be clear and the abdomen is benign. He is able to move all extremities well, with no obvious neurovascular compromise.
After removal from the backboard, he is sent to the radiology department for multiple scans. A static sagittal image from CT of the cervical spine is shown. What is your impression?
ANSWER
The image shows several things. First, there is a well-corticated lucency through the base of the odontoid process. This most likely represents what is referred to as an os odontoideum (congenital spinal variant). The other possibility is that it could be an old odontoid fracture with nonunion.
In addition, there are superior end-plate fractures noted in C6, C7, T1, and T2. However, no definite fracture lines are evident, suggesting these are subacute or old injuries. MRI can be performed to differentiate old versus new fractures; in this case, it was determined these were old.
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