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Cervical Posterior Column Injury
Kevin R. Moore, MD; Jeffrey S. Ross, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Pathology

        • Clinical Issues

          • Diagnostic Checklist

            TERMINOLOGY

            • Definitions

              • Posterior spinal column defined as structures dorsal to posterior longitudinal ligament
                • Superior and inferior articular facets, articular pillars, lamina and spinous processes
                • Facet joint capsules
                • Ligamentum flavum
                • Interspinous and supraspinous ligaments

            IMAGING

            • General Features

              • MR Findings

                • Imaging Recommendations

                  PATHOLOGY

                  • Staging, Grading, & Classification

                    CLINICAL ISSUES

                    • Presentation

                      • Natural History & Prognosis

                        • Treatment

                          DIAGNOSTIC CHECKLIST

                          • Image Interpretation Pearls

                            Selected References

                            1. Yang JS et al: Can posterior ligament structure be functionally healed after anterior reduction and fusion surgery in patients with traumatic subaxial cervical fracture-dislocations? World Neurosurg. 134:e243-8, 2020
                            2. Okada E et al: Spinal fractures in patients with diffuse idiopathic skeletal hyperostosis: clinical characteristics by fracture level. J Orthop Sci. 24(3):393-9, 2019
                            3. Yokota K et al: Progression of local kyphosis after conservative treatment for compressive cervical spine fracture with spinal cord injury. J Orthop Surg Res. 14(1):98, 2019
                            4. Dhillon CS et al: Outcomes of unstable subaxial cervical spine fractures managed by posteroanterior stabilization and fusion. Asian Spine J. 12(3):416-22, 2018
                            5. Aarabi B et al: Subaxial cervical spine injury classification systems. Neurosurgery. 72 Suppl 2:170-86, 2013
                            6. Bono CM et al: Reproducibility of radiographic measurements for subaxial cervical spine trauma. Spine (Phila Pa 1976). 36(17):1374-9, 2011
                            7. Dvorak MF et al: The surgical approach to subaxial cervical spine injuries: an evidence-based algorithm based on the SLIC classification system. Spine (Phila Pa 1976). 32(23):2620-9, 2007
                            8. Rabb CH et al: Unilateral cervical facet fractures with subluxation: injury patterns and treatment. J Spinal Disord Tech. 20(6):416-22, 2007
                            9. Vaccaro AR et al: The subaxial cervical spine injury classification system: a novel approach to recognize the importance of morphology, neurology, and integrity of the disco-ligamentous complex. Spine (Phila Pa 1976). 32(21):2365-74, 2007
                            10. Moore TA et al: Classification of lower cervical spine injuries. Spine (Phila Pa 1976). 31(11 Suppl):S37-43; discussion S61, 2006
                            11. Rao SK et al: Spectrum of imaging findings in hyperextension injuries of the neck. Radiographics. 25(5):1239-54, 2005
                            12. Matar LD et al: "Spinolaminar breach": an important sign in cervical spinous process fractures. Skeletal Radiol. 29(2):75-80, 2000
                            13. Zhu Q et al: Traumatic instabilities of the cervical spine caused by high-speed axial compression in a human model. An in vitro biomechanical study. Spine. 24(5):440-4, 1999
                            14. Shanmuganathan K et al: Traumatic isolation of the cervical articular pillar: imaging observations in 21 patients. AJR Am J Roentgenol. 166(4):897-902, 1996
                            15. Plezbert JA et al: Fracture of a lamina in the cervical spine. J Manipulative Physiol Ther. 17(8):552-7, 1994
                            16. Shanmuganathan K et al: Rotational injury of cervical facets: CT analysis of fracture patterns with implications for management and neurologic outcome. AJR Am J Roentgenol. 163(5):1165-9, 1994
                            17. Goldberg AL et al: Hyperextension injuries of the cervical spine. Magnetic resonance findings. Skeletal Radiol. 18(4):283-8, 1989
                            18. Allen BL Jr et al: A mechanistic classification of closed, indirect fractures and dislocations of the lower cervical spine. Spine (Phila Pa 1976). 7(1):1-27, 1982
                            Related Anatomy
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                            Related Differential Diagnoses
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                            References
                            Tables

                            Tables

                            KEY FACTS

                            • Terminology

                              • Imaging

                                • Pathology

                                  • Clinical Issues

                                    • Diagnostic Checklist

                                      TERMINOLOGY

                                      • Definitions

                                        • Posterior spinal column defined as structures dorsal to posterior longitudinal ligament
                                          • Superior and inferior articular facets, articular pillars, lamina and spinous processes
                                          • Facet joint capsules
                                          • Ligamentum flavum
                                          • Interspinous and supraspinous ligaments

                                      IMAGING

                                      • General Features

                                        • MR Findings

                                          • Imaging Recommendations

                                            PATHOLOGY

                                            • Staging, Grading, & Classification

                                              CLINICAL ISSUES

                                              • Presentation

                                                • Natural History & Prognosis

                                                  • Treatment

                                                    DIAGNOSTIC CHECKLIST

                                                    • Image Interpretation Pearls

                                                      Selected References

                                                      1. Yang JS et al: Can posterior ligament structure be functionally healed after anterior reduction and fusion surgery in patients with traumatic subaxial cervical fracture-dislocations? World Neurosurg. 134:e243-8, 2020
                                                      2. Okada E et al: Spinal fractures in patients with diffuse idiopathic skeletal hyperostosis: clinical characteristics by fracture level. J Orthop Sci. 24(3):393-9, 2019
                                                      3. Yokota K et al: Progression of local kyphosis after conservative treatment for compressive cervical spine fracture with spinal cord injury. J Orthop Surg Res. 14(1):98, 2019
                                                      4. Dhillon CS et al: Outcomes of unstable subaxial cervical spine fractures managed by posteroanterior stabilization and fusion. Asian Spine J. 12(3):416-22, 2018
                                                      5. Aarabi B et al: Subaxial cervical spine injury classification systems. Neurosurgery. 72 Suppl 2:170-86, 2013
                                                      6. Bono CM et al: Reproducibility of radiographic measurements for subaxial cervical spine trauma. Spine (Phila Pa 1976). 36(17):1374-9, 2011
                                                      7. Dvorak MF et al: The surgical approach to subaxial cervical spine injuries: an evidence-based algorithm based on the SLIC classification system. Spine (Phila Pa 1976). 32(23):2620-9, 2007
                                                      8. Rabb CH et al: Unilateral cervical facet fractures with subluxation: injury patterns and treatment. J Spinal Disord Tech. 20(6):416-22, 2007
                                                      9. Vaccaro AR et al: The subaxial cervical spine injury classification system: a novel approach to recognize the importance of morphology, neurology, and integrity of the disco-ligamentous complex. Spine (Phila Pa 1976). 32(21):2365-74, 2007
                                                      10. Moore TA et al: Classification of lower cervical spine injuries. Spine (Phila Pa 1976). 31(11 Suppl):S37-43; discussion S61, 2006
                                                      11. Rao SK et al: Spectrum of imaging findings in hyperextension injuries of the neck. Radiographics. 25(5):1239-54, 2005
                                                      12. Matar LD et al: "Spinolaminar breach": an important sign in cervical spinous process fractures. Skeletal Radiol. 29(2):75-80, 2000
                                                      13. Zhu Q et al: Traumatic instabilities of the cervical spine caused by high-speed axial compression in a human model. An in vitro biomechanical study. Spine. 24(5):440-4, 1999
                                                      14. Shanmuganathan K et al: Traumatic isolation of the cervical articular pillar: imaging observations in 21 patients. AJR Am J Roentgenol. 166(4):897-902, 1996
                                                      15. Plezbert JA et al: Fracture of a lamina in the cervical spine. J Manipulative Physiol Ther. 17(8):552-7, 1994
                                                      16. Shanmuganathan K et al: Rotational injury of cervical facets: CT analysis of fracture patterns with implications for management and neurologic outcome. AJR Am J Roentgenol. 163(5):1165-9, 1994
                                                      17. Goldberg AL et al: Hyperextension injuries of the cervical spine. Magnetic resonance findings. Skeletal Radiol. 18(4):283-8, 1989
                                                      18. Allen BL Jr et al: A mechanistic classification of closed, indirect fractures and dislocations of the lower cervical spine. Spine (Phila Pa 1976). 7(1):1-27, 1982