![]() ![]() The first-line investigation with percutaneous angiography is overly aggressive. At this time, MR angiography cannot be listed as the sole imaging modality for the evaluation of vertebral artery injury. Level-III evidence suggests that patients with C1 to C3 fractures can be screened with multi-slice multi-detector CT angiography. CT angiography can be coupled to CT imaging upon fracture evaluation with consideration of kidney function. (The skull sits on top of the atlas.) The dens projects into a central space in the. (The axis is the 2nd highest spinal bone.) The atlas is the first bone of your neck it sits on top of the axis. It is important to note that an untreated vertebral artery injury has a 24% stroke rate. The odontoid process, also known as the dens, is an upward projectile of bone that arises from the front part of the center of the axis vertebra. Of which, type-III odontoid fractures posed the greatest risk. Indeed, in one series, 15% of patients with C1 to C2 fractures had a vertebral artery injury. The vertebral artery’s second segment (V2) runs through the transverse foramen of C2 to C6, while V3 runs extradurally, exiting the C2 foramen across the sulcus arteriosus. An intact transverse ligament is needed for the anterior placement of an odontoid screw. Furthermore, MRI evaluation is mandatory in evaluating the transverse ligament for the surgical decision matrix of non-displaced type II odontoid fractures. MRI is less dangerous than flexion-extension cervical injury. T2 signal hyperintensities and STIR changes within the dens, ligaments, or soft tissue can illustrate an acute component. MRI is also useful for determining the acute nature of the fracture when this is otherwise unknown. This can be coupled with a CT angiogram (see below) for evaluation of the vascular anatomy.Įvaluation with MRI is important for analyzing the ligamentous construct, disc space, spinal cord, nerve roots, and other soft tissue injuries. Non-contrast CT scan is adequate for evaluation of the bony anatomy for fracture. It is important to recognize the importance that complete imaging will require dedicated thin-cut CT reconstructions. CT scan does not directly evaluate the spinal cord, soft tissue, or ligamentous construct. Even if plain films are negative and clinical suspicion is high, a CT scan is warranted. X-rays are an excellent modality for determining alignment during the immediate injury, post-operative period, as well as long-term follow-up.ĬT scan is the most important modality for determining fracture etiology and ruling out an injury regarding a C2 fracture. Approximately 93% of cervical spine injuries are apparent with combined, lateral, AP, and odontoid view radiographs. Lateral, anteroposterior (AP), and open mouth odontoid views are necessary. This is essential in reviewing cervical spine trauma. Care must be taken to ensure proper radiographic imaging creates a picture from the occiput to the C7 through T1 disc space. Normalized hemoglobin, hematocrit, coagulation profile with prothrombin time (PT), partial thromboplastin time (PTT), and platelet counts will be needed for operative intervention.Įvaluation of x-rays will provide limited but important information. Laboratory tests should be ordered as an adjunct in overall medical status. ![]()
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