Journal List > J Korean Orthop Assoc > v.42(4) > 1012677

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

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.

Figures and Tables

Fig. 1
The supporting structures and grading of soft tissue damage.
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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).
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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.
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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.
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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.
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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.
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Table 1
Overall Data in This Study
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*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
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Kappa coefficient test.

Table 3
The Correlations between the Grade of Soft Tissue Damage and the Spinal Cord Injury
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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
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*Retropharyngeal space; Retrotracheal space; oneway ANOVA, p<0.01.

Table 5
The Correlations between Spinal Stenosis and the Spinal Cord Injury
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chi-square test for trend, p=0.75.

Table 6
The Correlations between the Allen Classification and Grade of Soft Tissue Damage
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chi-square test for trend, p<0.01.

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