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Spectrum of Imaging Findings in Hyperextension Injuries of the Neck¹

¹ From the Department of Radiology, Hospital of Saint Raphael, Yale School of Medicine, New Haven, Conn. Recipient of a Certificate of Merit award for an education exhibit at the 2003 RSNA Annual Meeting. Received August 18, 2004; revision requested October 18 and received December 10; accepted January 27, 2005. All authors have no financial relationships to disclose. Address correspondence to S.K.R., Department of Diagnostic Radiology, Section of Musculoskeletal Imaging, University of Maryland Medical Center, 22 S Greene St, Baltimore, MD 21201 (e-mail: schenger{at}hotmail.com).

Nonphysiologic hyperextension and lateral forces acting on the cervical spine and soft-tissue structures of the neck can result in a wide spectrum of injury patterns. Multiple factors (eg, patient age; the underlying morphologic features of the cervical spine; the magnitude, vector, and maximal focus of the force) all influence the observed patterns and the severity of injury. A review of the 5-year trauma database in two trauma centers revealed various injury patterns that were frequently recognized in patients with clinical evidence or historical documentation of a predominant hyperextension mechanism. Injuries included anterior arch avulsion and posterior arch compression fractures of the atlas, odontoid fractures, traumatic spondylolisthesis and teardrop fracture of C2, laminar and articular pillar fractures, and hyperextension dislocation injuries. More severe injuries were observed in patients with underlying predisposing conditions (eg, degenerative spondylosis, ankylosing spondylitis, diffuse idiopathic skeletal hyperostosis). Knowledge of the involved biomechanical factors provides a framework for understanding these injury patterns. Diagnostic imaging, especially computed tomography and magnetic resonance imaging, plays a fundamental role in the assessment of patients with suspected cervical injury. Furthermore, cross-sectional imaging facilitates the recognition of accompanying injuries to the face, the head, and the vascular structures of the neck.

© RSNA, 2005