spine
Subaxial Cervical Spine Trauma
advanced
6 min
28 marks
6 questions
Clinical Scenario
A 35-year-old man is brought in after diving into shallow water. He has neck pain and weakness in both arms worse than his legs. He has numbness in a cape distribution. CT shows a C5 burst fracture with 50% canal compromise. His motor exam shows 3/5 power in biceps and deltoids bilaterally, 4/5 in triceps, and 4/5 in lower extremities.
Sagittal and axial CT images demonstrating a C5 burst fracture with loss of vertebral body height, retropulsed posterior wall fragment causing canal compromise of approximately 50%. The posterior ligamentous complex appears intact on CT. MRI shows cord compression with edema. This represents a subaxial cervical injury requiring SLIC scoring for treatment decision.
Image source: Open Access medical literature (NIH/PubMed Central) • CC-BY License
Questions
Question 1 (4 marks)
Describe the imaging findings and apply the SLIC classification.
Question 2 (5 marks)
Explain the SLIC scoring system and how it guides treatment.
Question 3 (6 marks)
What is the role of MRI and how do you assess the PLC?
Question 4 (5 marks)
What are the surgical options and approach selection?
Question 5 (4 marks)
Describe the technique for anterior corpectomy and fusion.
Question 6 (4 marks)
What are the expected outcomes and complications?
Exam Day Cheat Sheet
Must Mention
- •SLIC score (Morphology + DLC + Neurology)
- •≥5 = surgery, ≤3 = non-op
- •PLC assessment with MRI
- •Anterior for burst/retropulsion
- •Posterior for PLC disruption
- •STASCIS: early surgery (<24h)
- •Corpectomy for significant retropulsion
Common Pitfalls
- •Not using SLIC
- •Missing PLC injury
- •Wrong approach
- •Delayed surgery
- •Incomplete decompression
- •Missing posterior wall