Soft Tissue Damage in Cervical Spine Extension Injury

Kyung-Jin Song; Gyu-Hyung Kim; Seong-Il Wang; Ju-Hong Lee

doi:10.4055/jkoa.2007.42.4.433

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Song, Kim, Wang, and Lee: Soft Tissue Damage in Cervical Spine Extension Injury

Original Article

Journal of the Korean Orthopaedic Association

Journal of the Korean Orthopaedic Association 2007; 42(4): 433-443.

Published online: 31 August 2007

DOI: https://doi.org/10.4055/jkoa.2007.42.4.433

Soft Tissue Damage in Cervical Spine Extension Injury

Kyung-Jin Song, M.D., Gyu-Hyung Kim, M.D., Seong-Il Wang, M.D., Ju-Hong Lee, M.D.

Department of Orthopedic Surgery, College of Medicine, Research Institute of Clinical Medicine, Chonbuk National University, Jeonju, Korea.

Address reprint requests to Kyung-Jin Song, M.D., Ph.D. Department of Orthopedic Surgery, Chonbuk University Hospital, 634-18, Geumam-dong, Deokjin-gu, Jeonju 561-712, Korea. Tel: +82.63-250-1760, 1770, Fax: +82.63-271-6538, kysong@chonbuk.ac.kr

Abstract

Purpose

To diagnose the extent of soft tissue damage with MRI, and to evaluate the relationship between soft tissue damage and a spinal cord injury in an extension injury to the lower cervical spine trauma.

Materials and Methods

Eighty-one patients who treated surgically for an anextension injury to the cervical spine over the past 5 years, were analyzed. All patients had undergone MRI after the injury, and for the specific grading of soft tissue damage, the grades were defined from grades 1 to 5.

Results

The spinal cord injury developed with more than grade 3 soft tissue damage associated with a rupture of the posterior longitudinal ligament (p<0.01). The changes in signal intensity of the spinal cord also developed according to the severity of soft tissue damage (p<0.01). There was no relationship between the soft tissue damage and the spinal cord injury in spinal stenosis (p=0.75).

Conclusion

The extent of soft tissue damage was diagnosed precisely with MRI, and there was an close relationship between the soft tissue damage and spinal cord injury in the distractive-extension injury to the lower cervical spine trauma.

Keywords: Lower cervical trauma, Distractive-extension injury, Grading of soft tissue damage, Spinal cord injury

Figures and Tables

Fig. 1

The supporting structures and grading of soft tissue damage.

Fig. 2

Grade I soft tissue damage according to the MRI finding. Rupture of ALL C6-7 and an avulsion fracture of the superior end plate of C7 (①).

Fig. 3

Grade II soft tissue damage according to the MRI finding. Rupture of the ALL (①) and posterior extrusion of the disc material (②) of C5-6 and 6-7.

Fig. 4

Grade III soft tissue damage according to the MRI finding. Rupture of ALL (①), posterior extrusion of disc material (②) and rupture of the PLL (③) of C4-5, C5-6 and C6-7.

Fig. 5

Grade IV soft tissue damage according to the MRI finding. Rupture of the ALL (①), posterior extrusion of disc material (②), rupture of the PLL (③) and rupture of the ligamentum flavum and interspinous ligament (④) of C5-6.

Fig. 6

Grade V soft tissue damage according to the MRI finding. Rupture of the ALL (①), posterior extrusion of disc material (②), rupture of the PLL (③), rupture of the ligamentum flavum and interspinous ligament (④), and rupture of the posterior neck muscle (⑤) of C3-4 and C4-5.

Table 1

Overall Data in This Study

^*Injury mechanism; ^†Injury level; ^‡Grade of soft tissue damage; ^§Spinal cord injury; ^∥Spinal cord injury; ^¶Spinal cord compression change; ^**Spinal stenosis; ^††Retropharyngeal space; ^‡‡Retrotracheal space.

Table 2

The Inter-observer (K1) and Intra-observer (K2) Reliability of the Standard

Kappa coefficient test.

Table 3

The Correlations between the Grade of Soft Tissue Damage and the Spinal Cord Injury

Chi-square test for trend, spinal cord injury, p<0.01; Cord compression, p=0.5; Cord signal change, p<0.01.

Table 4

Measurement of the Retropharyngeal and Retrotracheal Space

^*Retropharyngeal space; ^†Retrotracheal space; oneway ANOVA, p<0.01.

Table 5

The Correlations between Spinal Stenosis and the Spinal Cord Injury

chi-square test for trend, p=0.75.

Table 6

The Correlations between the Allen Classification and Grade of Soft Tissue Damage

chi-square test for trend, p<0.01.

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