ARRS 2022 Abstracts

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E1853. What a Pain in the Neck! Imaging Features of Ligamentous Cervical Spine Injuries
Authors
  1. Karen Cheng; University of California, San Diego
  2. Marin McDonald; University of California, San Diego
Background
Cervical spine injury is common in the setting of trauma, and unstable injuries may be associated with devastating injuries to the spinal cord. Although CT is a mainstay for evaluation, many associated or purely ligamentous injuries to the cervical spine that are critical to spinal stability may be missed on initial CT. This exhibit reviews the imaging findings of ligamentous injuries to the cervical spine and the treatment implications.

Educational Goals / Teaching Points
This exhibit teaches radiologists and trainees to: 1) define the normal ligamentous anatomy of the cervical spine, including at the craniocervical junction; 2) recognize the normal appearance of these structures; 3) describe the types of injuries that may be associated with various mechanisms; and 4) identify features of both frank and subtle injury to these structures.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
This case-based exhibit utilizes a combination of CT and MRI findings in patients with history of acute spinal trauma to show: 1) the best imaging planes and sequences for visualization of the normal ligamentous structures of the cervical spine; 2) disruption of the alar ligaments in the setting of atlanto-occipital injury; 3) tearing of the transverse ligament in the setting of atlanto-axial injury; 4) injury to the interspinous and supraspinous ligaments with flexion-type injuries; and 5) accompanying findings such as traumatic disc extrusion, epidural hematoma, bone contusion, or spinal cord injury that may not be identifiable in the absence of MRI.

Conclusion
Cervical spine trauma is common and the ligamentous structures of the cervical spine, particularly at the craniocervical junction, are important to maintaining spinal stability. Radiologists need to understand the normal anatomy of these structures to recognize and report injuries that may determine whether surgical management is appropriate, as well as dictate the appropriate surgical approach. Although CT has become an integral part of the initial evaluation of patients with suspected cervical spinal injury, MRI may provide valuable information on important non-osseous findings.