Spinal cord transection

There are bilateral jumped facets at C6 with fracture of the bilateral C6 lamina and grade 4 anterolisthesis of C6, which is completely in front of and overlapping C7. The spinous process of C5 overlaps the lamina of C6. There are comminuted fractures of the bilateral facets at C6 and C7. There are chip fractures of the anterior aspect of C7.

There is prevertebral swelling centered at the C6-C7 level. There is an acute angulation of the spinal canal at C6-C7. There is an additional oblique fracture through the left aspect of the C6 vertebral body. There is an acute minimally displaced fracture of the right transverse process of C4, C6, and C7. The fracture of C6 involves the transverse foramen.

On the CTA portion of the exam, the vertebral arteries enhance well including the region of injury noted without evidence of dissection or extravasation at the time of the scan. There is no evidence of dissection of the carotid arteries.

Anterior cervical discectomy and fusion changes from C6 to T1 with C7 corpectomy, as well as posterior spinal fixation changes from C4 to T2.

There is diffusely abnormal, expansile intramedullary heterogeneous T2 signal extending from the cervical medullary junction inferiorly throughout the cervical and visualized thoracic spinal cord. Some areas have corresponding subtle intrinsic T1 hyperintensity and susceptibility artifact, likely representing blood products. Posterior to the C6 and C7 vertebral bodies, there is a relatively more homogeneous T2 signal, without significant visible spinal cord parenchymal signal, concerning for transection.

The multiple osseous spinal fractures were better visualized on the prior CT. There is significant paravertebral edema and disruption of the posterior tension band from C6 to approximately T1.