Case 7727

Posterior ligamentous injury of the

cervical spine
Published on 02.10.2009

DOI: 10.1594/EURORAD/CASE.7727
ISSN: 1563-4086
Section: Neuroradiology
Case Type: Clinical Cases
Authors: De Cocker L Jr, Vanderschueren G.
Patient: 6 years, female

Clinical History:

A 6 year old girl was brought to the emergency department after sustaining a cervical hyperflexion injury following a
fall from a swing.
Imaging Findings:

At presentation, the girl complained of neck pain without radiation. She had suffered no loss of consciousness and
clinical examination revealed no neurological abnormality. Plain radiographs and CT of the cervical spine showed
widening of the intervertebral space at the C6-C7 level without evidence for fractures. MRI of the cervical spine was
performed to exclude ligamentous injury. Turbo inversion recovery (TIR) sequences showed marked hyperintensity
and stretching of the interspinous ligament, and disruption of the ligamentum flavum at the C6-C7 level. There was
associated hyperintensity of the ligamentum nuchae and right paravertebral posterior muscle compartment. The
anterior and posterior longitudinal ligaments were intact. Vertebral body fractures with minimal height loss and
subdiscal bone marrow oedema were identified at the levels T1 through T4. The girl was treated conservatively with
a cervical collar and did well.
Discussion:

MRI is the best modality to evaluate ligamentous spinal injury. Normal ligaments appear hypointense on all
sequences because of their low water content. TIR sequences nicely demonstrate the high signal intensity oedema
and haemorrhage in and around an injured ligament. Obliteration of the fat between adjacent spinous processes on
T1WI, in combination with high signal on T2WI, indicates interspinous ligamentous sprain. Injury to the ligamentum
flavum is seen as focal disruption or as high T2 signal on MRI.
Differential Diagnosis List: Rupture of the ligamentum flavum and interpinous ligament sprain.

Final Diagnosis: Rupture of the ligamentum flavum and interpinous ligament sprain.

References:

Goradia D, Linnau KF, Cohen WA, Mirza S, Hallam DK, Blackmore CC. Correlation of MR Imaging Findings with
Intraoperative Findings after Cervical Spine Trauma. AJNR Am J Neuroradiol 2007 Feb;28(2):209-15. (PMID:
17296981)
Keiper MD, Zimmerman RA, Bilaniuk LT. MRI in the assessment of the supportive soft tissues of the cervical spine
in acute trauma in children. Neuroradiology. 1998 Jun;40(6):359-63. (PMID: 9689622)
Figure 1
a

Description: Interruption of the ligamentum flavum and marked hyperintensity and stretching of the
interspinous soft tissues at the C6-C7 level. Also note subdiscal marrow edema and minimal height loss
of T1 through T4 due to associated vertebral body fractures. Origin:
b

Description: Hyperintensity of the ligamentum nuchae and right paravertebral posterior muscle
compartment due to soft tissue edema. Origin:
c

Description: Normal signal intensities of the left paravertebral posterior cervical muscle compartment
(as opposed to figure 3b). Origin:
Figure 2
a

Description: Lateral radiograph shows widening of the C6-C7 disc space and interspinous distance.
Origin:
Figure 3
a

Description: CT shows isolated widening of the C6-C7 disc space and interspinous distance.Origin:
Figure 4
a

Description: Sagittal T1-weighted image showing obliteration of the normal fat signal between the
spinous processes of vertebra C6 and C7 due to soft tissue edema. Origin: