Review Question - QID 106411

The patient’s CT scan suggests a cervical burst fracture, which commonly results in anterior cord syndrome. Anterior cord syndrome is characterized by bilateral loss of pain and temperature sensation and loss of motor function, but bilateral preservation of positional and vibratory sensation.

Burst fractures commonly occur in high-energy axial trauma such as motor vehicle accidents or sporting events. The axial forces result in fracture and displacement of the vertebral body outwards and posteriorly, which may result in impingement of the anterior cord. Burst fractures can occur in both the cervical as well as thoracolumbar spine. Diagnosis typically involves plain film, although CT scan is increasingly used to assess cord involvement.

Graber and Kathold discuss the use of cervical spine radiographs in the trauma patient. They emphasize that the cervical spine series should include posteroanterior, lateral, and odontoid views. Inadequate imaging is the most common reason for a missed diagnosis of cervical spine injury.

Dai et al. compare plain radiography and CT scan in the diagnosis and management of thoracolumbar burst fractures. They conclude that, while plain films generally are adequate in the diagnosis of burst fractures, CT scans are required for treatment planning.

Figure A is a CT scan of a burst fracture in the cervical spine. Note the fracture fragment (white arrow) that is displaced into the spinal canal.
Illustration A is a schematic of the lesions in anterior cord syndrome.

Incorrect answers:
Answer 1: Loss of vibration sensation on the ipselateral side with loss of pain and temperature on the contralateral side of the body describes Brown-Sequard syndrome, which is generally seen in penetrating trauma.
Answer 2: Bilateral loss of pain and temperature sensation in shoulders and upper extremities is seen in syringomyelia, also known as central cord syndrome.
Answer 4. Bilateral loss of pain and temperature below the lesion would be seen in an isolated injury to the lateral spinothalamic tracts bilaterally, which generally is not seen in burst injuries.
Answer 5. Bilateral loss of position and vibration below the lesion is the pattern of posterior column syndrome, a very rare condition that can be caused by disruption of the posterior spinal artery.