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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.
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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