C5 burst fracture with R vertebral artery dissection

Findings:

A highly comminuted burst fracture involves the C-5 level, associated with significant retropulsion of the C5 body causing canal compromise. Facet malalignment is seen laterally. The axial CT soft tissue window image demonstrates a ventral epidural hematoma with mass effect on the spinal cord. The CTA images demonstrate grade 3 dissection of the right vertebral artery with subtotal occlusion.

Discussion:

Also known as a flexion teardrop fracture, forced hyperflexion and axial loading leads to sagittal fracture plane with significant retropulsion causing canal compromise. Cervical spine fractures, particularly when involving transverse foramina can lead to vascular injury, although less common than might be expected for the mechanism of the injury. The degree of fracture displacement or involvement of transverse foramen does not seem to correlate precisely with the severity of dissection.

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